Professor Paul Hofman, Director of the RespirERA Institute, coauthored an article published on November 3, 2026, in ILCN, the news outlet of the International Association for the Study of Lung Cancer (IASLC). Together with two international experts, he explores the benefits and limitations of comprehensive tumor testing in early-stage lung cancer.
Biomarkers to Help Guide Treatment
Two people with the same type of cancer may have tumors with different biological characteristics. Identifying these differences helps medical teams select treatments that are more likely to benefit each patient.
Testing for biomarkers (measurable biological characteristics, such as a gene change or the presence of a protein) provides this information. Laboratory testing can be performed on a sample collected during a biopsy (a procedure to remove a small piece of tissue) or surgery.
This approach contributes to precision medicine (care tailored to the biological characteristics of a disease). It may also help identify a clinical trial suited to the tumor’s profile.
Why Testing Also Matters for Operable Lung Cancer
The article focuses on early-stage non-small cell lung cancer (a major group of lung cancers). For some patients whose tumors can be surgically removed, drug treatments may be offered before or after surgery.
The choice of certain targeted therapies (drugs directed at a specific abnormality in cancer cells) depends on changes in genes such as EGFR or ALK. Other tests help guide the use of immunotherapy (treatment that helps the immune system fight cancer).
Having test results available when treatment decisions are made is therefore essential.
The quality and amount of tumor tissue collected, along with the organization of testing, affect access to personalized care.
Testing Multiple Biomarkers at Diagnosis
An international expert consensus cited in the article supports testing for multiple genetic alterations and assessing PD-L1 (a protein used to guide certain immunotherapy decisions) at diagnosis in non-metastatic lung cancer (cancer that has not spread to distant parts of the body).
Next-generation sequencing, or NGS (a technique that examines multiple genes at the same time), can support this analysis. The goal is to provide useful information for treatment planning.
However, some approaches are still being evaluated. These include the routine use of circulating tumor DNA (fragments of DNA released by a tumor into the bloodstream) to guide treatment decisions before and after surgery.
Integrating Testing into the Care Pathway
In their article, Paul Hofman, Kurt A. Schalper, and Fernando Lopez-Rios also highlight practical challenges, including costs, the interpretation of certain results, and testing turnaround times. These tests need to fit into the care pathway without unnecessarily delaying surgery.
Understanding a tumor’s characteristics from diagnosis requires reliable tests and coordination among medical teams. The goal is to make biological information available when it can help guide treatment choices.
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