Comprehensive molecular testing is now central to non-small cell lung cancer care, and a fast, reliable way to deliver it is reflex testing—where pathologists automatically initiate biomarker assays per team-defined rules at diagnosis. This approach minimizes delays and increases testing completeness: in a single-institution cohort, comprehensive molecular testing at initial diagnosis rose from 39.2% to 45.8%, with 96% of tests triggered via the reflex pathway. Standard panels (eg, 50- and 500-gene next-generation sequencing [NGS]) inform frontline therapy and clinical-trial options. PD-L1 remains important but isn’t the sole determinant. In early stages, EGFR and ALK are must-knows, while broader NGS is favored in higher-risk or complex scenarios to guide future decisions if disease progresses.
Operationally, many centers start testing at biopsy, returning 50-gene results in about 7 to 8 business days and larger panels a few days later; immunohistochemistry is often run externally. Experts stress not just whether to test but when: initiating reflex testing ensures oncologists have results at the first visit, reducing empiric starts on suboptimal regimens. A key nuance: in never-smokers, a “negative” NGS warrants confirmation (repeat tissue or alternative sampling) to avoid missing rare fusions or alterations. The takeaway: build reflex pathways, use NGS up front—especially in complex cases—and verify negatives in low-tobacco-exposure patients to get the appropriate therapy started on time.
Reference: Doherty K. Widespread Reflex Testing Closes Molecular Testing Gaps in NSCLC. OncLive. Published January 14, 2026. Accessed January 20, 2026. https://www.onclive.com/view/widespread-reflex-testing-closes-molecular-testing-gaps-in-nsclc
Link: https://www.onclive.com/view/widespread-reflex-testing-closes-molecular-testing-gaps-in-nsclc
