# Standing reflex biomarker panels per tumour type, run without an oncologist's order

Source: https://onco.cc/ideas/idea-acc-reflex-biomarker-panels-by-tumour/  
OnCo record `idea-acc-reflex-biomarker-panels-by-tumour` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

For each cancer type, agree the set of stains and tests that are always needed, and have the lab run them automatically on diagnosis rather than waiting for someone to ask.

## Summary

Beyond genomic profiling, predictive tests such as PD-L1, mismatch repair, HER2 in gastric and colorectal cancer, and HPV/p16 in oropharynx are ordered inconsistently, delaying or denying effective therapy. A national or hospital-level reflex protocol per tumour type, maintained against current guidelines, would make testing complete and timely. Reflex mismatch-repair testing in colorectal cancer for Lynch syndrome is an established precedent.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Reflex panels will raise completeness of guideline-required predictive biomarkers at first oncology visit to above 95% and cut time from diagnosis to first-line treatment decision by at least a week.
- Rationale: Testing that depends on an individual clinician remembering to order it will always be incomplete; making it a laboratory default removes the failure mode.
- Proposed test: Implement reflex panels in a regional laboratory network and audit completeness, turnaround, and downstream therapy use before and after.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Fragmented care and guideline gaps): Hanna et al., Mortality due to cancer treatment delay: systematic review and meta-analysis (BMJ 2020): https://doi.org/10.1136/bmj.m4087

## Connected records

- ideas: [Pathologists order genomic profiling automatically at diagnosis of advanced cancer](https://onco.cc/ideas/idea-acc-reflex-genomic-profiling-at-diagnosis/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- terms: [Combined positive score (CPS)](https://onco.cc/terms/cps/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/)
- key papers: [Mortality due to cancer treatment delay: systematic review and meta-analysis](https://onco.cc/key-papers/paper-hanna-bmj/)

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