Shuangshoti Shanop, Prasongsook Naiyarat, Thamlikitkul Lucksamon, Reungwetwattana Thanyanan, Poungvarin Naravat, Jinawath Artit, Teerapakpinyo Chinachote, Vinyuvat Songkhun, Sriuranpong Virote
Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Royal College of Pathologists of Thailand, Bangkok, Thailand.
Transl Lung Cancer Res. 2025 Jul 31;14(7):2387-2402. doi: 10.21037/tlcr-2025-201. Epub 2025 Jul 28.
Growing understanding of the heterogenous molecular profiles of non-small cell lung cancer (NSCLC) has led to changes in the treatment landscape of advanced NSCLC towards precision medicine to target actionable gene alterations. Practical barriers, such as lack of awareness/understanding of biomarkers, suboptimal quality or sample management, inappropriate use of biomarker testing results, limited patient access to biomarker tests and targeted treatments, and reimbursement/payment challenges, hinder the wider adoption of guideline-recommended biomarker testing. Limited reimbursement of targeted therapies is a key consideration for Thai oncologists when making a treatment choice for their patients with advanced NSCLC in Thailand. We aim to assess the current state of biomarker testing and treatment for advanced NSCLC in Thailand and provide recommendations to facilitate timely access to appropriate therapies, enhance patient quality of life, and optimize the use of Thailand's existing healthcare schemes.
The expert panel comprising one clinical pathologist, three anatomic pathologists, one molecular geneticist, and four medical oncologists convened to review recent literature, discuss current clinical practice, and prioritize essential topics for biomarker assessment and management of advanced NSCLC in Thailand. Following the meeting, further discussions on these prioritized topics were conducted via email, and the recommendations were developed.
Our recommendations include adopting an exclusionary strategy for biomarker testing, emphasizing the role of a multidisciplinary team (MDT) in managing patients with advanced NSCLC, and underscoring the importance of laboratory accreditation and external quality assurance programs. Additionally, we highlight the need for high-quality data on the local impact of novel treatments to assist policymakers in making these therapies accessible to suitable patients.
By proposing practical strategies tailored to our local healthcare setting, such as exclusionary biomarker testing approach, MDT involvement, and robust quality assurance measures, we provide a roadmap for improving the diagnosis and treatment of advanced NSCLC.
对非小细胞肺癌（NSCLC）异质分子谱的认识不断加深，促使晚期NSCLC的治疗格局朝着精准医学方向转变，以靶向可操作的基因改变。然而，一些实际障碍阻碍了指南推荐的生物标志物检测的更广泛应用，如对生物标志物缺乏认识/理解、质量或样本管理欠佳、生物标志物检测结果使用不当、患者获得生物标志物检测和靶向治疗的机会有限以及报销/支付方面的挑战。在为泰国晚期NSCLC患者选择治疗方案时，靶向治疗的有限报销是泰国肿瘤学家的一个关键考虑因素。我们旨在评估泰国晚期NSCLC生物标志物检测和治疗的现状，并提供建议，以促进及时获得适当治疗、提高患者生活质量并优化泰国现有医疗保健计划的使用。
由一名临床病理学家、三名解剖病理学家、一名分子遗传学家和四名医学肿瘤学家组成的专家小组召开会议，回顾近期文献、讨论当前临床实践，并确定泰国晚期NSCLC生物标志物评估和管理的重要主题优先级。会议后，通过电子邮件对这些优先主题进行了进一步讨论，并制定了建议。
我们的建议包括采用生物标志物检测的排除策略、强调多学科团队（MDT）在管理晚期NSCLC患者中的作用，以及强调实验室认证和外部质量保证计划的重要性。此外，我们强调需要关于新治疗方法对当地影响的高质量数据，以协助政策制定者使这些治疗方法能够为合适的患者所用。
通过提出针对我们当地医疗环境的实用策略，如排除性生物标志物检测方法、MDT参与和强有力的质量保证措施，我们为改善晚期NSCLC的诊断和治疗提供了路线图。
