In practice, EGFR and ALK testing is usually performed upon request by the medical oncologist. However, several consensus statements and local policies advocate reflex molecular testing (by pathologists) upon diagnosis of non-SCC NSCLC, regardless of clinical stage.82,83 This policy has been shown to increase the rate of molecular testing by approximately one-third in some settings84 and reduce the time to initiating treatment.82,85 In a recent study from Toronto, Canada, Cheema et al compared outcomes during routine and reflex biomarker testing among 306 patients with newly diagnosed NSCLC. Reflex EGFR/ALK testing was associated with a significant improvement in time to optimal systemic therapy, as defined by published guidelines (from 36 to 24 days).82
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