Initial biomarker testing strategies and clinical outcomes in advanced non-small cell lung cancer

Appropriate initial biomarker testing is essential for treatment selection in patients with advanced non-small cell lung cancer (NSCLC). We conducted a multicenter retrospective study comparing single-plex and multiplex testing strategies for driver oncogene detection and clinical outcomes. Single-plex testing was associated with a higher detection rate of epidermal growth factor receptor (EGFR) mutations, greater use of EGFR tyrosine kinase inhibitors, and longer overall survival than multiplex testing. These findings suggest that limitations in the sensitivity of currently available multiplex platforms may influence downstream treatment opportunities, particularly in populations with a high prevalence of EGFR mutations. Our results support further optimization of multiplex assays and evaluation of sequential testing strategies for patients without detected driver oncogenes on initial testing.