Pathologists order genomic profiling automatically at diagnosis of advanced cancer

Overview

• Protocol upgrade, graded promising: the benefit of matched targeted therapy is established, but the evidence that reflex ordering itself improves outcomes comes from before-and-after series rather than randomised comparisons. At one academic centre with a reflex protocol, 61.0 per cent of 501 patients with stage II to IV non-squamous non-small-cell lung cancer had sequencing results before any first treatment and 88.4 per cent before systemic therapy (Smilnak, 2026); at another, the median time from procedure to sequencing report fell from 22 to 20 days after reflex ordering began (Major, 2025).
• Adoption gap, as measured: in United States claims and laboratory data from an industry repository, 497 of every 1,000 patients with newly diagnosed advanced non-small-cell lung cancer were lost to precision oncology at the testing steps, and 29.2 per cent of those who did receive a result did not receive the matching treatment (Sadik, 2022). In a national survey of 111 professionals involved in lung cancer biomarker testing, 77.5 per cent reported an institutional protocol and 88.4 per cent of those protocols reflexed to a multigene panel, but fewer reported results arriving before the visit at which first-line treatment was chosen; reimbursement, insurance authorisation and the Medicare 14-day rule were the barriers named (Savaloja Pineault, 2026).