Speaker's Highlight

• Don Sin University of British Columbia, St. Paul Hospital (Canada)
  Kenneth R. Chapman Toronto General Hospital Research Institute (Canada)
• Parameswaran Nair McMaster University (Canada)
  Carolyn Calfee UCSF (U.S.A.)
• Gregory P. Downey University of Colorado School of Medicine (U.S.A.)
  David A. Schwartz University of Colorado School of Medicine (U.S.A.)
• Neil Schluger Tuberculosis Control Branch, California Department of Public Health (U.S.A.)
  Nick Kim Critical Care & Sleep Medicine, University of California San Diego (U.S.A.)
• Nicola Hananiah Baylor College of Medicine (U.S.A.)
  Jae-Joon Yim Seoul National University College of Medicine (Republic of Korea)
• Koichiro Asano Tokai University School of Medicine (Japan)
  Diahn-Warng Perng Taipei Veterans General Hospital (Taiwan)
• Konstantinos Kostikas University of Ioannina (Greece)
  Karin Klooster University Medical Center Groningen (Kingdom of the Netherlands)

• Personalized Care Pathways in Non-Small Cell Lung Cancer

  Non-small cell lung cancer (NSCLC) is a diverse group of diseases rather than a single condition. Tumors that appear similar under a microscope may have different genetic drivers, immune profiles, growth patterns, and treatment sensitivities. Personalized medicine uses these differences to guide decisions from diagnosis through long-term follow-up.

  Advances in molecular oncology have expanded the role of biomarker testing in respiratory medicine. Genomic profiling, immunohistochemistry, liquid biopsy, and carefully selected clinical trials can help clinicians identify the most appropriate therapy for an individual patient while reducing exposure to treatments that are unlikely to work.

  For specialists, multidisciplinary teams, and healthcare professionals attending respiratory medicine congresses, this approach also highlights the importance of collaboration. Pathologists, pulmonologists, thoracic surgeons, oncologists, radiologists, genetic counselors, and pharmacists all contribute to a coordinated treatment pathway.

  Why Tumor Biology Matters

  NSCLC includes adenocarcinoma, squamous cell carcinoma, and less common histological subtypes. Within each category, molecular alterations can activate signaling pathways that promote cancer growth. Identifying these changes may reveal an actionable target and influence the order in which treatments are given.

  Clinical factors remain essential. Performance status, comorbidities, smoking history, organ function, metastatic sites, symptoms, and patient preferences must be considered alongside genomic results. A molecular finding has clinical value only when it is interpreted in the context of the whole patient.

  Personalized care therefore means more than ordering a large sequencing panel. It involves obtaining a reliable diagnosis, selecting relevant biomarkers, discussing results in a multidisciplinary setting, and revisiting the treatment plan as the disease evolves.

  Biomarker Testing At Diagnosis

  For patients with advanced non-squamous NSCLC, broad molecular testing is generally important before systemic therapy begins. Depending on regional guidelines and available technology, testing may include EGFR, ALK, ROS1, BRAF V600E, KRAS G12C, MET exon 14 skipping, RET, NTRK, and HER2 alterations. Additional biomarkers may be incorporated as evidence and regulatory approvals develop.

  PD-L1 expression is commonly assessed to estimate the potential benefit of immune checkpoint inhibitors. However, PD-L1 is not a substitute for oncogenic driver testing. A patient with a targetable alteration may require a different initial strategy even when PD-L1 expression is high.

  Testing methods vary. Next-generation sequencing can evaluate multiple genes from a single specimen, while fluorescence in situ hybridization, polymerase chain reaction, immunohistochemistry, and other assays may be appropriate for specific alterations. Laboratories should use validated methods with clear quality-control standards.

  Tissue, Blood, And Diagnostic Precision

  Tissue biopsy remains central to diagnosis, histological classification, and many biomarker assessments. The sample should be collected and processed with care because inadequate tissue can delay treatment or require another invasive procedure. Communication between the interventional team, pathology laboratory, and oncology service helps preserve material for essential tests.

  Liquid biopsy analyzes circulating tumor DNA in blood and can be useful when tissue is difficult to obtain, insufficient, or unsafe to access. It may also identify resistance mutations during treatment. A negative plasma result does not always exclude a genomic alteration, because the tumor may shed little DNA into the bloodstream; tissue testing may still be needed when clinically feasible.

  Clinical question	Useful information	Common limitation
  Is there an actionable driver?	Broad genomic profiling from tissue or plasma	Some alterations may be missed by limited panels
  Is immunotherapy appropriate?	PD-L1 expression and clinical context	PD-L1 alone does not predict response perfectly
  Has resistance developed?	Repeat tissue or liquid biopsy	Tumor heterogeneity can produce incomplete results
  Is a biopsy safe and adequate?	Imaging, procedural assessment, pathology review	Small or poorly preserved samples may limit testing

  Matching Treatment To The Patient

  When a targetable driver is identified, an appropriately selected targeted therapy may offer rapid disease control and symptom improvement. Treatment choice can depend on central nervous system activity, toxicity profile, drug interactions, access, and the patient’s preferences. Monitoring should include both radiographic response and clinically meaningful outcomes.

  Resistance is expected in many advanced cancers. It may arise through a new mutation, pathway bypass, histological transformation, or changes within different tumor deposits. At progression, repeat molecular assessment can clarify whether another targeted option, local treatment, chemotherapy, immunotherapy, or a clinical trial is appropriate.

  Targeted treatment should be accompanied by structured toxicity management. Rash, diarrhea, liver abnormalities, pneumonitis, cardiac effects, and neurological symptoms vary by drug class. Early recognition and patient education can help maintain treatment continuity and protect quality of life.

  Immunotherapy And Combination Strategies

  Immune checkpoint inhibitors targeting the PD-1, PD-L1, or CTLA-4 pathways have changed the treatment of advanced NSCLC. Depending on stage, biomarker status, histology, and patient fitness, immunotherapy may be used alone or combined with platinum-based chemotherapy and other agents.

  The expected benefit must be balanced against immune-related adverse events. Pneumonitis is especially important in a respiratory cancer population, where cough and breathlessness may also result from infection, tumor progression, radiation injury, or chronic lung disease. Prompt assessment is essential when new respiratory symptoms appear.

  The role and timing of immunotherapy can differ for patients with oncogenic driver alterations, particularly when targeted therapies are available. Treatment sequencing should be based on current evidence, local guidance, safety considerations, and multidisciplinary review rather than a single biomarker result.

  Integrating Patient Values And Clinical Evidence

  Personalized medicine includes personal priorities. Some patients may prioritize extending survival, while others place greater weight on symptom control, preserving independence, minimizing hospital visits, or avoiding specific adverse effects. Shared decision-making makes these preferences visible during treatment planning.

  Supportive care should begin early and continue alongside anticancer therapy. Smoking cessation, pulmonary rehabilitation, nutrition, pain management, psychological support, palliative care, and management of treatment-related symptoms can improve the patient experience across the disease course.

  Clinical trials are another important route to individualized care. Studies may evaluate new targeted agents, antibody-drug conjugates, cellular therapies, biomarker-guided combinations, or strategies for overcoming acquired resistance. Trial eligibility should be considered early, before standard treatment options become limited.

  Building A Reliable Multidisciplinary Pathway

  • Establish reflex or streamlined biomarker testing for eligible NSCLC cases.
  • Use broad genomic profiling when several actionable alterations are clinically relevant.
  • Review complex results through a molecular tumor board or multidisciplinary cancer team.
  • Repeat molecular testing at progression when the result could change treatment.
  • Include symptom control, supportive care, and patient goals in every treatment discussion.

  A reliable pathway also requires measurable standards. Teams can monitor the time from biopsy to molecular result, the proportion of eligible patients tested, rates of inadequate specimens, and access to clinical trials. These indicators reveal practical barriers that may be invisible in individual consultations.

  Education is equally important. Respiratory physicians and allied professionals need ongoing familiarity with emerging biomarkers, drug toxicities, interpretation of variants, and referral routes. Collaboration across institutions can help extend access to advanced diagnostics and specialist expertise.

  The future of NSCLC care will depend on integrating molecular data with imaging, digital pathology, real-world outcomes, and patient-reported information. At APSR- and KATRD-connected professional gatherings, discussions among regional and international experts can support the responsible adoption of these advances in everyday respiratory practice.

  Personalized medicine is most effective when precision testing is paired with clinical judgment, compassionate communication, and timely reassessment. Explore the congress program, committee expertise, and invited-speaker sessions to follow the latest developments in biomarker-driven lung cancer care and translate emerging evidence into better patient pathways.

  Richard Russell Nuffield Department of Clinical Medicine, University of Oxford (United Kingdom)
• Mona Bafadhel King’s College London (United Kingdom)
  David Jackson Guy’s and St Thomas’ Hospital, King’s College London (United Kingdom)
• James Chalmers University of Dundee (United Kingdom)
  David Price University of Aberdeen (United Kingdom)