Shifting from clinician-ordered to pathologist-initiated reflex testing for NSCLC biomarkers combines diagnosis and molecular analysis into one workflow. This operational change minimizes delays, increases testing rates, and optimizes the use of small biopsy samples, getting actionable results to oncologists faster.

Contrary to common belief, low biomarker testing rates (30-60%) are not just a community oncology problem; even academic medical centers are "guilty" of failing to test all eligible GI cancer patients. This highlights a systemic challenge in implementing personalized medicine, requiring proactive strategies at all levels of care.

To reduce treatment delays, pathologists should initiate biomarker testing reflexively. Waiting for a medical oncologist to order tests at a first visit is a system failure, wasting critical time and risking the need to retrieve archived samples.

Standard Next-Generation Sequencing (NGS) reports often just state "MET amplification" without a specific copy number. To make informed treatment decisions with MET inhibitors, clinicians must proactively contact the testing company's molecular pathology department to obtain this crucial, unlisted data point.

Establishing a multi-disciplinary molecular tumour board helps operationalize biomarker strategies. This collaborative body, including oncologists and surgeons, not only interprets complex molecular data for trial matching but also collectively advocates for health insurance reimbursement for necessary tests, addressing a key practical barrier.

Clinicians ordering "NGS for lung" often misunderstand that Next-Generation Sequencing alone does not cover all actionable biomarkers, such as PD-L1 or HER2. This requires pathologists to interpret the clinician's intent and order a more comprehensive and appropriate test panel.

Data shows an average two-week delay occurs between a lung cancer patient's biopsy and the ordering of essential biomarker tests. This administrative gap, separate from the diagnostic process itself, is a major bottleneck that postpones critical treatment decisions.

While re-biopsying at disease progression is the "by-the-book" standard to confirm biomarkers like HER2, clinicians acknowledge it is often skipped. The difficulty of obtaining tissue and the desire to provide patients with potential treatment options create a gap between guidelines and clinical reality.

When the FDA approves a new biomarker-linked therapy, an in-house pathology lab actively queries its historical database of all prior NGS tests to identify past cases with the relevant genetic alteration. They then proactively contact the oncologists for these patients, uncovering new treatment options that were previously unavailable.