Advances in biomarkers, targeted therapies, and immuno-oncology have transformed the clinical management of patients with advanced NSCLC. For oncogene-driven tumors, there are highly effective targeted therapies against EGFR, ALK, ROS1, BRAF, TRK, RET, and MET. In addition, investigational therapies for KRAS, NRG1, and HER2 have shown promising results and may become standard-of-care in the near future. In parallel, immune-checkpoint therapy has emerged as an indispensable treatment modality, especially for patients lacking actionable oncogenic drivers. While PD-L1 expression has shown modest predictive utility, biomarkers for immune-checkpoint inhibition in NSCLC have remained elusive and represent an area of active investigation. Given the growing importance of biomarkers, optimal utilization of small tissue biopsies and alternative genotyping methods using circulating cell-free DNA have become increasingly integrated into clinical practice. In this review, we will summarize the current landscape and emerging trends in precision medicine for patients with advanced NSCLC with a special focus on predictive biomarker testing.

生物标志物、靶向治疗和免疫肿瘤学的进步已经改变了晚期 NSCLC 患者的临床管理。对于致癌基因驱动的肿瘤，有针对 EGFR、ALK、ROS1、BRAF、TRK、RET 和 MET 的高效靶向疗法。此外，针对 KRAS、NRG1 和 HER2 的研究性疗法已显示出可喜的结果，并可能在不久的将来成为标准治疗。与此同时，免疫检查点疗法已成为一种不可或缺的治疗方式，尤其是对于缺乏可操作致癌驱动因素的患者。虽然 PD-L1 表达已显示出适度的预测效用，但 NSCLC 中免疫检查点抑制的生物标志物仍然难以捉摸，并且代表了一个积极研究的领域。鉴于生物标志物的重要性日益增加，小组织活检的最佳利用和使用循环游离 DNA 的替代基因分型方法已越来越多地融入临床实践。在这篇综述中，我们将总结晚期 NSCLC 患者精准医疗的现状和新兴趋势，特别关注预测性生物标志物检测。