There is an expanding list of therapeutically relevant biomarkers for non-small cell lung cancer (NSCLC), and molecular profiling at diagnosis is paramount. Tissue attrition in scaling traditional single biomarker assays from small biopsies is an increasingly encountered problem. We compared the performance of targeted NGS panels with traditional assays and correlated the mutational landscape with PD-L1 status in Singaporean patients with the National Lung Profiling (NLP) study. A cost-effectiveness analysis of NGS compared to standard molecular testing was conducted. The study demonstrated that even in an EGFR mutant predominant population, upfront NGS represented a feasible, cost-effective method of diagnostic molecular profiling compared with sequential testing strategies. These results support the implementation of diagnostic NGS in non-squamous NSCLC in Asia to allow patients access to the most appropriate personalized therapy.

Learning Objectives:
1. To recognise key considerations for the routine clinical implementation of next-generation sequencing
2. To appraise the cost-effectiveness of diagnostic next-generation sequencing for metastatic lung cancer