Community Oncology Insights: Panel Discusses Molecular Testing Approaches, Barriers

At the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, an expert panel convened to discuss non–small cell lung cancer (NSCLC), with an emphasis on young-onset lung cancer, psychosocial considerations, and the evolution of molecular testing and targeted therapy in NSCLC.

Moderated by Millie Das, MD, of Stanford University and the Palo Alto VA, the roundtable featured perspectives from Martin Dietrich, MD, PhD, of the US Oncology Network; Stephen Liu, MD, of Georgetown University; and Eric Singhi, MD, of the University of Texas MD Anderson Cancer Center.

In the third segment of this roundtable discussion, the panel discusses molecular testing for NSCLC in a community oncology setting, as well as the unique challenges and considerations associated with molecular testing outside of large academic centers.

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Dr. Das: Martin, let’s talk about molecular testing in more of a community setting.  It’s easy for a lot of us who work at academic centers to say, “We have reflexive testing, and we usually get results back quickly.” But in reality, we know a lot of patients—most patients—are treated in the community, and it’s not necessarily straightforward. Patients may be getting biopsies at other institutions before they come to see you. It’s unclear whether they’ve even had the molecular testing ordered.

What are some of the barriers and challenges you’ve seen with some of the patients that you’re treating in terms of those results being available in terms of the NGS [next-generation sequencing] even being ordered?

Dr. Dietrich: I think that’s a big problem. We’re getting patients through many referral channels. There’s not one good, structured way and not one contact person in pathology that we can work with. It’s sometimes a dozen hospitals or more that provide biopsies for our patients that are being referred for management. That makes the value of liquid biopsy even higher.

We are less in charge of tissue, and we oftentimes have to depend on the individual practices, or what Stephen was alluding to, that we are getting involved in tissue stewardship and the conservation of tissue for molecular testing as a priority. That’s very difficult to do if you have no working relationship with the pathologists and the interventionalists that are procuring and processing the tissue. For us, this poses a frequent challenge. We see a fair amount—about one in four—”quantity not sufficient” tissues and also a need for re-biopsy.

There are some things we can learn from liquid biopsy. We’ve talked a lot about DNA and RNA, but we’re also evolving into an era of antibody-drug conjugates where immunohistochemistries (IHCs) are becoming more and more important again and certainly require more and more tissue.

Unfortunately, oftentimes, when a patient comes to me, we obtain a liquid biopsy with a preliminary diagnosis of cancer, but we oftentimes set up a concurrent repeat tissue biopsy to procure enough tissue to allow us to give the patient the full spectrum of opportunities for treatment. It’s really challenging, and unfortunately, there’s not a good way to harmonize it.

My ideal scenario would be that the interventionalist has in mind [that] this is a lung cancer based on the radiographic impression and communicates with the pathologist to obtain NGS testing. We need it now in the early- and late-line setting. We don’t have an inappropriate stage anymore for disease sequencing or disease genotyping.

In my opinion, we should develop broader protocols that are applicable, similar, like we do in other cancer types where reflexive markers are obtained. I understand it’s more sophisticated in lung cancer with NGS as a baseline requirement, but we need all biomarkers upfront. Whatever we can do to get patients to those results—and therefore to treatment faster—is what we need to do.

Dr. Das: Yes. Martin, you hit on the IHC testing. We know that we have a recent approval for telisotuzumab vedotin, an antibody-drug conjugate for patients who have high c-Met expression, and this is [defined as] three-plus on IHC testing. How are we going to incorporate IHC testing on top of NGS testing for our patients? Eric, some thoughts?

Dr. Singhi: Yes. It’s really tough, to be honest. You just alluded to the “quantity insufficient” for a lot of patients, and every test we do is more tissue. Tissue is the issue for a lot of these tests, unfortunately, and we struggle with that amount.

That being said, this is a biomarker. It’s a new biomarker that we should be testing for. It’s another option for patients. The study that you’re alluding to showed almost a 40%-plus rate of response in some of these patients. That’s really impressive to be able to offer that to patients. If we don’t test, we won’t know, and then they may not have that option.

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View the first segment of this roundtable series, titled “The Changing Face of Lung Cancer: Experts Discuss the Rising Incidence in Young Adults.”

View the second segment of this roundtable series, titled “Molecular Testing in Lung Cancer: Experts Review Progress, Challenges at ASCO 2025.”