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This website is intended for UK Healthcare professionals only. Other UK residents please visit astrazeneca.co.uk
Epidermal growth factor receptor mutation (EGFRm) testing is an essential step to identify non-small cell lung cancer (NSCLC) patients who are eligible for treatment with EGFR tyrosine kinase inhibitors (EGFR-TKIs).1,2 This means eligible patients may benefit from therapies which are targeted at this mutation.
EGFRm can be identified using both tissue testing or ctDNA testing (please note, ctDNA testing is only suitable for NSCLC Stages III and IV). In fact, ctDNA testing can be performed earlier in the diagnostic pathway, even before tissue biopsy is arranged; this allows for faster molecular profiling and significantly reduces time-to-treatment initiation. Whilst not an alternative to tissue biopsy, ctDNA complements the tissue pathway.3,4 This is now available on the National Genomic Test Directory in the UK, under test code M4.14 in England, and is now fully funded and considered routine in Stage III and IV NSCLC testing in most cases.5
Adapted from Malapelle U, et al. Mol Pathol. 2021; Hendriks LE, et al. Ann Oncol. 2023; and Pascual J, et al. Ann Oncol. 2022.6-8
North Thames Genomic Medicines Service
One of the two laboratories responsible for the majority of testing in the UK, this GMS has a very informative guide on how to get the most out of liquid biopsies, from the best process to how to interpret the results.11
Blood test first approach
The move by NHS England to drive this ctDNA ‘blood test first approach’ in 2025 has been discussed in the BMJ.12
Centres can organise their ordering of NSCLC biomarker testing in different ways:
Bespoke testing: when an oncologist orders tests for each individual patient.13
Reflex testing: when a standard group of pre-approved biomarker tests is ordered at the time of initial cancer diagnosis.13
There are a number of benefits of reflex testing compared to bespoke testing, including reduced turnaround time, and streamlining pathology workloads.13-15 Learn more about reflex testing in NSCLC below.
ctDNA can be utilised in first and second-line advanced (Stage III and IV) NSCLC settings and is now fully funded by NHS England; tissue biopsy in these cases can be used where ctDNA results are uninformative. This first-line ctDNA approach is particularly useful in the ≤30% of patients who do not receive a timely tissue biopsy result (which can be due to lack of available tissue, low-quality samples or poor health that prevents them from undergoing biopsy procedures), and to prevent multiple invasive biopsy procedures to re-test patients who have progressed on EGFR-TKIs.16
Reach out to the AstraZeneca Diagnostics Team if you would like to discuss EGFR testing strategies in more detail.
Please note some areas may have local testing hubs, check locally for request forms.
Adapted from NHS England Genomic Laboratory Hubs.17
Reflex testing is defined as ordering a standard group of pre-approved biomarker tests at the time of initial cancer diagnosis. EGFRm are included in reflex testing bundles as standard in NSCLC.13 The benefits of a reflex testing approach screening all tumours independent of staging (compared to bespoke testing) include:13-15
Watch the video below to hear more.
GB-63994 | July 2025
GB-74216| DOP : February 2026
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This website was created for UK HCPs and has been designed to provide information to educate, empower and enable them in the great work they are doing for patients across a range of therapy areas. This website is intended for doctors, nurses, and pharmacists in the UK. Other UK residents please visit astrazeneca.co.uk.