It can feel like everything changes in one phone call. A scan shows a mass. A biopsy is scheduled. Then suddenly you’re learning new words you never asked to learn: staging, nodes, metastasis.
In the middle of that whirlwind, “biomarker testing” can sound like a bonus feature. Something you’ll get to later, after the big decisions. But for many people with lung cancer, biomarker testing is one of the most important steps early on, because it helps your care team choose the treatment most likely to work for your specific tumor.1
This is also a health equity issue. People of color with lung cancer often face worse outcomes in part because of later diagnosis and gaps in treatment access.2 The American Lung Association notes that people of color are less likely to be diagnosed early, less likely to receive surgery, and more likely to receive no treatment compared with white patients.2
Knowing what to ask for, and when, helps protect your options.
What Lung Cancer Is
Lung cancer happens when abnormal cells in the lung grow out of control. The two main categories are:
- Non-small cell lung cancer (NSCLC), the most common type.3
- Small cell lung cancer (SCLC), which often grows and spreads faster.3
Your treatment plan depends on the type and stage, but for many people with NSCLC, another factor is just as important: whether the tumor has specific biomarkers that can be targeted with certain medicines.1
What Biomarker Testing Is
Biomarker testing (also called molecular testing, genomic testing, or molecular profiling) looks for changes in the tumor’s DNA, RNA, or proteins that can guide treatment choices.1
In practical terms, it helps answer questions like:
- Is there a mutation we can treat with a targeted pill?
- Will immunotherapy likely help, based on PD-L1 levels?
- Are there clinical studies that are looking to treat this type of tumor?
Major guidelines and expert groups emphasize testing for key biomarkers in advanced NSCLC (Non-small cell lung cancer) because targeted therapies can dramatically change treatment options.1
What “Common Testing” Looks Like For Lung Cancer
Most people experience lung cancer testing in phases.
First comes diagnosis and staging: imaging plus a biopsy to confirm cancer type.4
Then comes biomarker testing: using the biopsy tissue (or blood) to look for targetable changes.4
Two key ways biomarkers are tested:
- Tissue testing: uses tumor tissue from a biopsy or surgery.4
- Liquid biopsy (blood test): looks for tumor DNA circulating in the blood (ctDNA).4 It can be helpful when tissue is limited or results are needed quickly, but tissue testing is still important in many cases.4
A common modern approach is “panel” testing (next-generation sequencing, or NGS), which checks many biomarkers at once instead of ordering one test at a time.4
Biomarkers People Should Know To Ask About
When someone says “biomarker testing,” they’re talking about looking for specific changes in the tumor that can guide treatment.1 In lung cancer, many of these changes are like “on switches” that make cancer cells grow. If your tumor has one of these switches, there may be a targeted medicine designed to block it, often as a pill.1
Other biomarkers help predict whether immunotherapy may help. Guidelines commonly recommend upfront comprehensive molecular testing in advanced non-small cell lung cancer (NSCLC) for key driver biomarkers including EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, NTRK, HER2 (ERBB2), plus PD-L1.1
Here’s what each one means in real life:
1) EGFR: EGFR is a gene that can develop changes (mutations) that tell cancer cells to keep growing. If EGFR is positive, people may benefit from EGFR-targeted therapy, which can be very different from standard chemo.1
Self-advocacy line: “Was my tumor tested for EGFR, and if it’s positive, what targeted options are recommended first?”
2) ALK: ALK changes usually come from a “rearrangement,” meaning the gene gets reconnected in a way that drives cancer growth. ALK-positive cancers often respond well to ALK inhibitors.1
Self-advocacy line: “Do I have an ALK rearrangement, and if so, what’s the first-line targeted treatment?”
3) ROS1: ROS1 is another rearrangement that can drive cancer. It’s less common, but important because it can open targeted therapy options.1
Self-advocacy line: “Was ROS1 tested with a broad panel, and can I see the full report?”
4) HER2 (also called ERBB2): HER2 changes in lung cancer are not the same as “HER2-positive breast cancer,” but they can still be important. Certain HER2 mutations can point toward specific targeted strategies and clinical trials.1
Self-advocacy line: “Was HER2/ERBB2 tested, and if positive, what treatments or trials does that open?”
5) BRAF: BRAF mutations can act like a stuck accelerator pedal in a cell growth pathway. Some BRAF changes have specific targeted treatments.1
Self-advocacy line: “Do I have a BRAF mutation, and is it the kind that has targeted treatment options?”
6) KRAS (including KRAS G12C): KRAS mutations are common in NSCLC. For years they were considered “not targetable,” but now certain KRAS mutations (like G12C) can have targeted options, depending on the situation.1
Self-advocacy line: “Was KRAS tested, and if it’s KRAS G12C, does that change my treatment plan or trial options?”
7) MET (including MET exon 14 skipping): MET is a growth signaling gene. One specific change, MET exon 14 skipping, can make MET overactive and is important because it may qualify you for targeted therapy.1
Self-advocacy line: “Was MET tested, including MET exon 14 skipping specifically, and what does the result mean for my options?”
8) RET: RET rearrangements can drive some lung cancers. If RET is positive, targeted options may be available and can be very effective for the right patient.1
Self-advocacy line: “Was RET tested, and if positive, is targeted therapy recommended before chemo or immunotherapy?”
9) NTRK: NTRK gene fusions are rare, but they matter because they can open access to targeted therapies that are used across different cancers when this fusion is present.1
Self-advocacy line: “Was NTRK tested as part of my panel? If it wasn’t, can we add it?”
10) PD-L1: PD-L1 is a protein found on tumor cells (or nearby immune cells). PD-L1 testing helps guide the use of immunotherapy, but it’s not the whole story.1
A key point from major clinical guidance: even when PD-L1 is high, you often still want to wait for broad molecular results, because if you have a strong driver mutation, the best first treatment may be targeted therapy instead of immunotherapy.
Self-advocacy line: “What is my PD-L1 level, and are we waiting for the full molecular panel before choosing immunotherapy?”
Step-By-Step: How To Advocate for Biomarker Testing
- Step 1: Ask what type of lung cancer you have and what stage you’re in.
- Step 2: Ask whether biomarker testing has been ordered, and whether it’s comprehensive.
- Step 3: Ask whether you have enough tissue for testing.
- Step 4: Ask when results will be back and whether treatment can wait for them.
- Step 5: Get a copy of the results and have someone explain them in plain language.
- Step 6: If something is “negative,” ask what was actually tested.
Why Bringing a Trusted Person Helps
Cancer visits are information-dense. A trusted person can: take notes, ask follow-up questions, and help you remember what was decided.
This is especially helpful when you’re hearing new terms, processing fear, or feeling rushed. Bringing support isn’t a loss of independence. It’s a strategy for clarity.
Grounded Call To Action Tied To NOWINCLUDED
Biomarker testing is not a “nice to have.” It is a key that can unlock more precise treatment.
Inside the NOWINCLUDED app, bring your questions before your visit. Use the community to learn what to ask, what results mean, and how to push for complete testing without feeling like you’re being “difficult.”
You’re not being difficult. You’re being informed.
Open the NOWINCLUDED app, choose three questions from this guide, and bring them to your next appointment. Clarity is care, and asking early protects your options.
References
- ALA. (2026, January 20). Lung Cancer Biomarker Testing. Retrieved from American Lung Association : https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-diagnosis/biomarker-testing
- ALA. (2025). Racial and Ethnic Disparities. Retrieved from American Lung Association : https://www.lung.org/research/state-of-lung-cancer/racial-and-ethnic-disparities
- ACS. (2024, January 29). What Is Lung Cancer? Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/lung-cancer/about/what-is.html
- ACS. (2024, January 29). Tests for Lung Cancer. Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/lung-cancer/detection-diagnosis-staging/how-diagnosed.html
- Meernik, C., Raveendran, Y., Kolarova, M., Rahman, F., & Olunuga, E. (2024). Racial and ethnic disparities in genomic testing among lung cancer patients: a systematic review. Journal of the National Cancer Institute. doi:10.1093/jnci/djae026
