Challenges in molecular testing in non-small-cell lung cancer patients with advanced disease

Crispin T Hiley, John Le Quesne, George Santis, Rowena Sharpe, David Gonzalez de Castro, Gary Middleton, Charles Swanton

Research output: Contribution to journalArticlepeer-review

99 Citations (Scopus)


Lung cancer diagnostics have progressed greatly in the previous decade. Development of molecular testing to identify an increasing number of potentially clinically actionable genetic variants, using smaller samples obtained via minimally invasive techniques, is a huge challenge. Tumour heterogeneity and cancer evolution in response to therapy means that repeat biopsies or circulating biomarkers are likely to be increasingly useful to adapt treatment as resistance develops. We highlight some of the current challenges faced in clinical practice for molecular testing of EGFR, ALK, and new biomarkers such as PDL1. Implementation of next generation sequencing platforms for molecular diagnostics in non-small-cell lung cancer is increasingly common, allowing testing of multiple genetic variants from a single sample. The use of next generation sequencing to recruit for molecularly stratified clinical trials is discussed in the context of the UK Stratified Medicine Programme and The UK National Lung Matrix Trial.

Original languageEnglish
Pages (from-to)1002-1011
Number of pages10
JournalThe Lancet
Issue number10048
Early online date1 Sept 2016
Publication statusPublished - 3 Sept 2016


  • Biomarkers, Tumor
  • Carcinoma, Non-Small-Cell Lung
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Lung Neoplasms
  • Mutation
  • Receptor Protein-Tyrosine Kinases
  • Receptor, Epidermal Growth Factor
  • Severity of Illness Index
  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Review


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