The NCCN guidelines strongly recommend that all patients with advanced and metastatic lung adenocarcinoma receive comprehensive next-generation sequencing (NGS)-based testing that includes testing for alterations in the EGFR, ALK, ROS1, KRAS, BRAF, NTRK1/2/3, MET, RET, and ERBB2 (HER2) genes, in addition to PD-L1 testing. This list applies regardless of smoking history. Tiered approaches based on low prevalence of co-occurring biomarkers are acceptable (eg, rapid polymerase chain reaction [PCR]-based testing for EGFR, ALK, and ROS1 alterations) but NGS-based testing should be ordered concurrently. HER2 testing in particular is newly emphasized in the guidelines with the availability of an FDA-approved therapy.

Reference:
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version 3.2023. Updated April 13, 2023. Available at: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450