What is the best therapy for NSCLC adenocarcinoma?

Question

Hello doctor,

My father, aged 65, was recently diagnosed with non-small cell lung cancer (NSCLC), specifically adenocarcinoma. His biopsy showed programmed death-ligand 1 (PD-L1) expression of 40 percent, and his oncologist has recommended cancer genome testing (also called comprehensive genomic profiling) to look for targetable mutations.

So my questions are

How exactly does genome testing guide treatment in his case?
What actionable mutations should we be hoping to find, and what treatments are available based on them?
Does insurance usually cover the cost of this test, or is it considered experimental?
What is the treatment for NSCLC adenocarcinoma?
How long does it take to get the results, and will it delay his chemotherapy or immunotherapy?

Kindly suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

It is common to feel a bit lost when doctors mention advanced tests like cancer genome profiling. In lung cancer, especially adenocarcinoma, this test looks for specific genetic changes in the tumor.

If certain mutations are found, they can often be treated with targeted drugs rather than relying only on chemotherapy.

In your father’s case, his cancer type and PD-L1 (programmed death-ligand 1) status suggest that the oncologist is checking for mutations that could provide more treatment options beyond standard chemotherapy or immunotherapy.

The recommended investigations include:

Cancer genome profiling or next-generation sequencing (NGS) of the biopsy sample
Basic blood tests to check liver, kidney, and overall organ function.
Imaging studies, as advised by the oncologist, are for staging and monitoring.

The differential diagnosis has already ruled out other lung cancers, such as small cell and squamous cell carcinoma, based on biopsy findings. Benign lung lesions are also unlikely given the confirmed histology.

The most probable diagnosis is non-small cell lung cancer (adenocarcinoma). Genome testing may reveal mutations such as epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), B-Raf proto-oncogene (BRAF), or Kirsten rat sarcoma virus oncogene homolog (KRAS).

If one of these mutations is found, orally targeted medicines can be used. These are often more tolerable and effective than chemotherapy in selected patients.

If no mutation is found, treatment usually proceeds with chemotherapy and/or immunotherapy, especially since the PD-L1 score is 40 percent, which may make immunotherapy more effective. Results from genome profiling typically take two to three weeks.

This may cause a slight delay in starting treatment, but the oncologist will determine whether it is safe to wait. Insurance coverage for this test varies; some plans cover it if recommended by the oncologist, while others may not.

For follow-up, it is important to share the biopsy report and any imaging with the oncologist so they can decide whether treatment should begin while waiting for test results. Also, check with your insurance provider regarding coverage for the test.

The supportive measures include:

Avoid smoking and secondhand smoke.
Eat a balanced, nutritious diet to maintain strength during treatment.
Stay active within your limits.
Keep all follow-up appointments and promptly report new symptoms.

I hope this information helps you.

Thank you.