Molecular biomarker testing now guides treatment in oesophago-gastric cancer, with results for markers such as HER2, PD-L1 and MSI-H/dMMR shaping which targeted therapies a patient can receive. Across the UK NHS, though, testing is delivered inconsistently, depending on local pathways and funding, and that variation risks delaying the start of treatment. There has been no clear UK standard for how and when this testing should happen.
To define one, a steering group of oncologists and pathologists developed 36 statements across six domains. The statements were tested through a modified Delphi consensus, with a survey completed by 50 UK healthcare professionals including oncologists, pathologists, specialist pharmacists and nurses. Consensus was pre-specified at 75% agreement, with very strong agreement set at 90%.
Thirty-five of the 36 statements reached consensus. The recommendations set out concrete standards: all patients suitable for systemic therapy should be tested for HER2, PD-L1 and MSI-H/dMMR at diagnosis, results should be available within 10 days of request, and treatment should begin within 30 days of receiving them.
Triducive acted as the independent facilitator for this modified Delphi consensus, generating the statements and analysing the responses. The consensus supports a reflex testing approach that gives clinicians the biomarker results they need, when they need them.
Rodriguez-Justo M, et al. BMJ Open, 2025; 15(2): e094343. DOI: 10.1136/bmjopen-2024-094343
