Lung Cancer Molecular Testing Nears 70%, Still Falls Short of Universal Use: Christopher D'Avella, MD

Rates of broad molecular profiling for patients with newly diagnosed advanced non–small cell lung cancer (NSCLC) have improved, but gaps in testing before first-line treatment persist, according to thoracic oncologist Christopher A. D'Avella, MD, from the University of Pennsylvania, where he serves as section chief of hematology/oncology at Penn Presbyterian Medical Center, codirector of the Cancer Diagnostics Clinic, and assistant professor of clinical medicine.

In an interview at The American Journal of Managed Care^® Institute for Value-Based Medicine® event in Philadelphia on April 10, D’Avella noted that testing rates prior to first-line treatment have risen from roughly 50% in earlier studies to closer to 70% today, reflecting growing awareness of clinical guidelines and the expanding number of targetable mutations. Still, he emphasized that progress remains uneven and that missed or delayed testing continues to affect patient care.

Breakdowns often occur early in the diagnostic process, particularly depending on who performs the biopsy and whether molecular testing is automatically initiated. In cases where testing is not reflexively ordered, additional steps are required for a medical oncologist to request testing, increasing the risk of delays. For patients with symptomatic lung cancer, these delays can complicate timely treatment decisions.

“The goal is that every patient has testing completed before seeing a medical oncologist,” D’Avella explained, underscoring that treatment decisions should be informed by molecular results at the outset.

Variation across care settings also contributes to disparities. Academic centers are more likely to have standardized reflex testing protocols, while community settings may lack the same infrastructure, resources, or multidisciplinary coordination. D’Avella pointed to differences in expertise, availability of nurse navigators, and coordination among care teams as key factors influencing whether testing is completed.

He highlighted reflex testing as the most effective strategy to close these gaps. At academic institutions like the University of Pennsylvania, in-house reflex testing protocols can deliver results within 7 to 10 days, minimizing delays. Complementary strategies—such as nurse navigation and coordinated multidisciplinary care involving surgeons, pulmonologists, and pathologists—further streamline the process.