Lung cancer remains the leading cause of cancer death worldwide, and its epidemiology varies by region, sex, and smoking status—particularly among people who never smoked, who more often have adenocarcinoma with targetable biomarkers such as EGFR, ALK, HER2, and ROS1. Despite advances in targeted therapy, comprehensive biomarker testing is still largely concentrated in advanced-stage non–small cell lung cancer (NSCLC) and unevenly adopted. Researchers examined who gets tested and how testing relates to outcomes in a retrospective cohort of 8,267 adults with NSCLC (all stages) diagnosed between 2013 and 2020 in a large, diverse integrated health system, capturing both non-next-generation sequencing (NGS) and NGS testing plus key sociodemographic and clinical variables.

Overall, 38.9% of patients received biomarker testing, with higher rates in younger patients, Asian patients, never-smokers, those with stage IV disease, and those with adenocarcinoma or other non-squamous histology. Nearly all measured factors except sex were independently associated with testing, with particularly strong patterns in stage IV disease. In survival analyses, NGS testing was associated with lower 3-year all-cause mortality compared with no testing—especially in stage IV NSCLC. Non-NGS testing was linked to higher mortality in stage I to III disease, a finding the authors note may reflect unmeasured treatment differences and selection of patients with more aggressive or unresectable tumors. Overall, the study underscores underuse and inequities in biomarker testing, especially in early-stage disease and older adults. It also suggests that broader, systematic, and equitable implementation of comprehensive testing across all NSCLC stages may be critical to optimizing access to targeted therapies and improving outcomes.

Reference: Carroway WP, Alcasid NJ, Jarrin Lopez A, et al. Differences in biomarker testing in non-small cell lung cancer: real-world outcomes within an integrated healthcare system. Front Surg. 2025;12:1632360. doi: 10.3389/fsurg.2025.1632360.

Link: https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1632360/full