In unresectable stage III non-small-cell lung cancer the treatment pathway moves fast, and molecular testing frequently lands after the radiotherapy plan has been made. When a targetable driver turns up afterwards, the options have already narrowed.
So make the molecular result a prerequisite at the multidisciplinary meeting rather than an addendum to it. Ask three questions before the plan is signed: has tissue gone for testing, when will the result arrive, and what would change if it were positive. If the answer to the third is anything, the plan waits.
Where tissue is inadequate — common in stage III, where the diagnosis often comes from a small biopsy — request plasma circulating tumour DNA rather than repeating the bronchoscopy by reflex. It is faster, and a positive result is actionable even though a negative one does not exclude a mutation.
- Make the EGFR and ALK result a standing agenda item before any stage III plan is finalised.
- Ask what would change if the result were positive — if the answer is nothing, proceed.
- Use plasma circulating tumour DNA when tissue is inadequate; a positive result is actionable, a negative one is not conclusive.
- Record the expected turnaround time in the meeting note, so a delay is visible rather than discovered.
- In Indian practice, cost and turnaround for molecular testing vary widely between centres — establish the local reality before promising a timeline to the patient.
Why it matters
A targetable driver found after the plan is made is a driver found too late to shape it.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for oncology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free