For medical clinicians dedicated to lung cancer patients, the landscape of molecular testing is rapidly evolving. To ensure the highest standard of care, the Royal College of Pathologists of Australasia (RCPA), in collaboration with the Thoracic Oncology Group of Australasia (TOGA), has released comprehensive, evidence-based best practice recommendations for molecular testing of lung cancers in Australia.
This initiative aims to standardise genomic testing for non-small cell lung cancer (NSCLC) across Australia. Genomic testing identifies drug-targetable mutations in NSCLC, enabling many patients with Stage 4 disease to receive targeted therapies (TKIs). Unlike chemotherapy, TKIs have minimal toxicities and allow most people to continue working and living full lives.
Thanks to genomic testing—previously available only through research but now Medicare-funded for testing tumour tissue—some Australians with Stage 4 NSCLC have survived for over a decade, dramatically shifting expectations for this disease.
Why Should You, as a Clinician, Care?
You’re likely already implementing many of these practices. However, these guidelines offer a consolidated, evidence-driven framework that enhances your ability to provide optimal patient care. Here’s why:
- Guiding Targeted Therapy: Accurately identify actionable genetic mutations (e.g., EGFR, ALK, ROS1, BRAF, MET, RET, NTRK, HER2) to tailor treatment plans effectively.
- Immunotherapy Decision-Making: Leverage PD-L1 expression and other biomarkers (eg ALK, EGFR) to determine patient suitability for immune checkpoint inhibitors.
- Optimising Tissue Use: Prioritise testing and consider liquid biopsies (ctDNA) in situations of clinical urgency or where tissue is otherwise not obtainable
- Avoiding Unnecessary Testing & Costs: Streamline testing to ensure cost-effective, clinically relevant, and timely results.
Professor Nick Pavlakis, Medical Oncologist at the Royal North Shore Hospital and Chair of the TOGA Board of Directors emphasises,
"These best practice recommendations ensure every lung cancer patient in Australia has access to high-quality molecular testing, leading to more effective, targeted treatments. Standardising testing means faster, more precise care, giving patients the best chance at improved outcomes and quality of life."
Guideline Development Approach
A committee was set up to review the scoping document, confirm the key questions, debate and vote on the provisional evidence-based recommendations. This committee included:
- RCPA-nominated pathology representatives from each state
- TOGA-nominated oncology representatives from each state
- Two consumer representatives, nominated by RCPA and TOGA
Jon Graftdyk, a patient advocate at TOGA and founder of ALK Positive Australia, a specific lung cancer charity, played a key role in shaping the new molecular testing guidelines by ensuring they reflected patient needs. As someone who’s own ALK-positive lung cancer diagnosis was made possible through molecular testing – allowing him to access targeted therapy and avoid chemotherapy – Jon’s insights helped emphasise the life-changing impact of precision medicine. His contributions reinforced the importance of equitable access to testing, ensuring more patients benefit from the latest advancements in lung cancer care.
See Jon’s story on 9news here.
TOGA’s Commitment
The implementation of these guidelines is crucial for ensuring equitable and timely commencement access to the best personalised approach to lung cancer therapy.
TOGA remains dedicated to its mission: to prevent, treat, and cure thoracic cancers through research, clinical trials, education, and advocacy. These new guidelines are a significant step towards achieving that goal. We encourage all clinicians to familiarise themselves with these recommendations and implement them in their practice.
By embracing these best practices, we can collectively elevate the standard of lung cancer care in Australia, ensuring better outcomes for every patient.
More info on the Molecular testing Recommendations can be found below:
- Publication in the RCPA journal Pathology (open access)
- Media Release
- Launch and promotion at Pathology Update 2025
- A dedicated webpage on the RCPA website
