Optimizing Biomarker Testing in NSCLC to Expand Targeted Treatment Options

In an interview with Pharmacy Times at the 2026 Community Oncology Alliance (COA) Conference, Mya Tran, PharmD, BCOP, precision oncology-thoracic clinical pharmacist at IU Health Simon Cancer Center, discusses persistent gaps in biomarker testing for non–small cell lung cancer, particularly inconsistencies across community settings. She highlights the importance of early and comprehensive testing to guide frontline treatment decisions, especially when targeted therapies may be more effective than immunotherapy. Tran emphasizes the unique role pharmacists can play in leading testing workflows, leveraging genomic databases, and improving care coordination.

Pharmacy Times: In your session on biomarker-driven treatment in NSCLC, what are the most critical biomarkers community oncology practices should prioritize today to guide treatment decisions?

Mya Tran, PharmD, BCOP: So the way I think about it is I prioritize the biomarkers based on 2 different criteria. The first one is, “What are some of the biomarkers that have implications in the frontline treatment?” The second question I ask is, “What are the biomarkers that have implications regarding immunotherapy response?”

With that, PD-L1 exists to predict immunotherapy response. It is important, it should be done, and it’s easy to do. It can be done in-house at most institutions these days. Additionally, there are biomarkers that have frontline treatment options but predict resistance or limited efficacy of immunotherapies—things like EGFR sensitizing mutations or certain fusion-positive lung cancers, like ALK fusions and RET fusions—where we actually have really good frontline targeted therapies, and the data shows only very limited response to immunotherapy. These are the patient populations that we need to identify early so we can give them frontline targeted therapy instead of immunotherapies.

Pharmacy Times: You’ve been involved in standardizing biomarker testing—what are the biggest gaps or inconsistencies you’re seeing across community practices, and how can pharmacists help close those gaps?

Tran: I think the biggest gap that I’ve seen regarding biomarker testing in non-small cell lung cancer in the community setting is inconsistency. The chance of a patient with a diagnosis of non-small cell lung cancer getting testing almost purely depends on physician or provider preference. Some are very pro-testing—they test early and comprehensively. Others only test if there’s an indication based on clinical characteristics. For example, if the patient has limited or no smoking history or is young, there is more motivation for testing. Otherwise, testing is often delayed, or when patients do get tested, it’s with a very small molecular panel, which is definitely not adequate to detect all the biomarkers that we have approvals for these days in non-small cell lung cancer.

I understand why it is that way, because to do this right in the community setting is very challenging. We need collaboration with many different partners, like pulmonology and IR teams, to make sure there is enough tissue. We need to collaborate with pathology to ensure the tissue is properly procured, and we also need expertise to decide what types of biomarkers are needed and what platform should be used. In the community setting, this can be very challenging because providers see high volumes of patients with various disease states.

This is where I think a pharmacist can step in and help. I don’t think pharmacists alone are the answer, but we are in a unique position where we have an understanding of the disease state, biomarkers, and targeted therapies. We can help start different pipelines for testing, help oversee that process, and serve as the molecular expert that the disease team can rely on to get things done.

Pharmacy Times: As a precision oncology pharmacist, how do you translate complex genomic data into actionable treatment recommendations for clinicians, especially in fast-paced community settings?

Tran: In my job, I leverage genomic databases a lot to make decisions. At IU, we are very fortunate to have a home-built tool that is very sophisticated and can process genomic data and pull from different databases to make my job easier. But in the community setting, it’s not that easy. When I don’t have access to that tool, there are public databases that I can use—some are free and some require a subscription—but most of the time you can get a lot of useful information for free. OncoKB, CIViC, and JAX-CKB are examples I addressed in my talk, and they contain a lot of valuable information. So I leverage genomic databases as much as I can to make clinical decisions.

The second thing is leveraging new AI technologies to improve workflows. At IU, we partner with genomic solution platforms—AI-based tools—to help increase the accuracy and efficiency of our genomic interpretation workflow. That has been very helpful.

I do want to point out that this requires a lot of work and resources. For this to be successful, pharmacists need support from leadership and the institution. This is not just another task that a community pharmacist can take on—they will require adequate training, tools, and dedicated time to make this happen.

Pharmacy Times: From your experience in thoracic oncology, how does pharmacist involvement in biomarker-driven care improve patient outcomes, particularly in lung cancer?

Tran: Yes, I do believe pharmacists can make a difference. These are data that we haven’t had a chance to publish yet, but at IU, my role involves somatic interpretation of molecular testing for all solid tumors across the IU Health system. I’ve always been drawn to lung cancer because of its molecular complexity, so I’ve dedicated time to the lung cancer clinic and helped develop a lung cancer pipeline to standardize molecular testing for all lung cancer patients at the IU cancer institute.

We started this program in April 2024, and now we have 1 year of data. It’s very encouraging. We’ve seen a 30% increase in comprehensive molecular testing at our cancer institute, along with a 68% increase in detection of targetable therapies that are FDA-approved or guideline-recommended. This has added many treatment options for patients who otherwise would not have had them without testing.

One thing I’m especially proud of is that we were able to do all of this without causing additional financial burden for patients. Ninety percent of our patients received $0 copays for molecular testing, including many with early-stage non-small cell lung cancer and squamous histology, where financial concerns have traditionally been a barrier.

Another achievement is that, through close collaboration with pathology and vendors, we were able to drive down the failure rate of NGS testing to an average of 1.6% last year, compared to the national average of anywhere from 10% to 30%, depending on the dataset. So I do believe that with the right personnel, resources, and support, pharmacists can make a huge difference in patient care.