Overcoming Barriers to Widespread Neoadjuvant Lung Cancer Testing: Sandip Patel, MD

Patients with lower socioeconomic status were less likely to get certain biomarker testing done and had a longer time between their diagnosis and biomarker testing, according to research presented by Sandip P. Patel, MD, associate professor at the University of California San Diego School of Medicine, at the 2025 World Lung Cancer Conference, held September 6-9, 2025, in Barcelona, Spain.

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Transcript

Your poster shows that molecular biomarker testing is increasing over time but still has low rates in the neoadjuvant setting. Why do you think this is the case, and what are the key barriers preventing more widespread presurgical testing?

I think when we're looking at molecular testing in the neoadjuvant setting, it's increasingly important, similar to the metastatic setting, where EGFR puts you on one path with targeted therapy and away from immunotherapy; meanwhile, patients with other types of mutations benefit from chemoimmunotherapy. This is the exact same decision we now have to make in the early-stage setting, whether it be adjuvant treatment with EGFR or ALK, neoadjuvant/perioperative treatment with EGFR [or] ALK, or understanding when to use chemo [and] PD-1 combinations in the neoadjuvant or perioperative period.

I think it's become just as important to know the EGFR and PD-L1 status in the postoperative setting to make sure we get patients on the right treatment course. And we’ve got to do this in a rapid way, because we don't want to use up time in which the patient's cancer is progressing and now they're suddenly not a surgical candidate.

Patients in the lowest 2 socioeconomic quintiles had lower rates of PD-L1 testing and longer times from diagnosis to testing. What specific systemic or patient-level barriers do you believe are driving this disparity?

Social determinants of health are a critical aspect in us understanding where the patients are coming from and how to take care of the patient. We have to take care of the cancer by targeting it. We have to take care of the patient and we have to meet them where they're at. And this relates to social factors that determine their ability to receive certain types of treatment or receive certain types of testing.

Now, this falls into multiple baskets. One relates to often suboptimal insurance coverage for the type of testing or even type of treatment they may need to optimally fight their cancer. Then the second relates to all the social determinants of health that influence their ability to either receive the appropriate testing or faithfully receive the treatment without interruption. These are some of the social determinants of health factors that we've seen.

In our data set in this study, we found that those patients in lower socioeconomic status, unfortunately, had lower rates of testing and longer times to receiving treatment. Now, how much of that relates to insurance coverage vs if you have a 9-to-5 job that you have to keep every day and you can't make it to every clinic appointment—that's a social determinant of health—is something we're still trying to fully understand. I think making testing universally available for these patients is something that we should do as a society, because otherwise we're giving very expensive drugs as a guess, and that has its own expense as well, and it's worse for studies. I think getting at least one biomarker test covered is hugely important.

We wouldn't take care of any patient with breast cancer without knowing ERP [estrogen receptor protein] and HER2. I think similarly for patients with lung cancer, we have to know EGFR, ALK, and PD-L1 for all our patients, regardless of stage.