Utilizing NCCN Guideline Recommendations in Biomarker Testing

Current NCCN guidelines for early-stage NSCLC recommend testing for key biomarkers to guide decisions regarding adjuvant targeted therapy or immunotherapy. However, the rapidly expanding landscape of precision oncology in metastatic NSCLC suggests that a broader panel—including KRAS G12C, MET exon 14 skipping, RET, ROS1, BRAF, HER2, and NTRK—may also have relevance in earlier disease settings. Gaps in current recommendations include limited guidance on the full range of potentially actionable biomarkers and variability in testing practices across institutions. Future guideline iterations could address these gaps by incorporating broader molecular panels, standardizing reflex testing workflows, and aligning early-stage testing requirements with the innovations already established in advanced NSCLC.