Guidelines, Infrastructure, and Stakeholder Roles in Biomarker Testing for Extrapulmonary Neuroendocrine Carcinoma

In ‘Guidelines, Infrastructure, and Stakeholder Roles in Biomarker Testing for Extrapulmonary Neuroendocrine Carcinoma,’ the expert oncologists examined the following critical questions:

What do current National Comprehensive Cancer Network (NCCN) guidelines recommend in terms of biomarker testing for extrapulmonary neuroendocrine carcinomas?

Which updates will be necessary in future iterations?

Which stakeholders are involved in the testing infrastructure for biomarkers in extrapulmonary neuroendocrine carcinomas and what are their respective roles?

Led by the moderator, the panelists discussed how current NCCN guidelines for biomarker testing in extrapulmonary neuroendocrine carcinoma (epNEC) remain limited given the evolving evidence base, though future updates are anticipated as data mature around emerging targets such as delta-like ligand 3 (DLL3), ASCL1, and tumor-agnostic markers including microsatellite instability-high (MSI-H) and tumor mutational burden (TMB). Sandy Kotiah, William Oh, Namrata Vijayvergia, and Aman Chauhan emphasized the importance of comprehensive next-generation sequencing (NGS) at diagnosis and encouraged community oncologists to refer patients to centers with active clinical trials early — before relapse — to avoid delays in accessing novel therapies.

Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

Our next episode, ‘Clinical Pathways, Barriers, and Infrastructure Needs in Biomarker Testing for Extrapulmonary Neuroendocrine Carcinoma,’ further explores extrapulmonary neuroendocrine carcinoma, highlighting the role of clinical pathways in standardizing biomarker testing, the logistical and technical barriers that impede routine integration, and the infrastructure improvements needed to support broader adoption of biomarker-driven strategies.