The NCCN guidelines recommend that all patients with completely resected (R0) stages IB-IIIA, IIIB [T3,N2] NSCLC receive EGFR, ALK, and PD-L1 testing if they are under consideration for adjuvant systemic therapy.¹

• Patients with stage IB disease who are high risk can be considered for adjuvant chemotherapy followed by osimertinib if their tumor is EGFR-positive.¹
• Patients with stage IIA disease who are high risk can be considered for adjuvant chemotherapy followed by osimertinib if their tumors are EGFR-positive, atezolizumab if they are PD-L1-positive (≥1%), or pembrolizumab without regard to PD-L1 status (although evidence is limited for PD-L1 <1%). NCCN recommends consideration of EGFR and ALK as negative biomarkers for adjuvant atezolizumab or pembrolizumab, although there is no label restriction based on these biomarkers.^1,2
• Adjuvant chemotherapy is a category 1 recommendation for all patients with R0 stages IIB, IIIA, and IIIB [T3,N2] disease, with a recommendation for subsequent osimertinib, atezolizumab, or pembrolizumab therapy based on EGFR, ALK, and PD-L1 status as discussed above.¹
• Patients with stage IA disease are not candidates for adjuvant osimertinib, atezolizumab, or pembrolizumab, so testing is not part of management recommendations.^1,2

References:
1. 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

2. U.S. Food & Drug Administration (FDA). Oncology (Cancer) / Hematologic Malignancies Approval Notifications. Reviewed June 20, 2023. Accessed June 20, 2023. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm279174.htm