Patient selection for systemic therapy in non-small cell lung cancer (NSCLC) is based on immunologic (PD-L1) and genomic biomarkers. Availability of suitable tumour biospecimens can limit biomarker testing. Plasma genotyping is an emerging technology for biomarker testing in NSCLC. Completion of all recommended testing of NSCLC is challenging in our real world population and the rate of incomplete testing is not known. In order to assess this problem we aimed to evaluate 1. the rate of biomarker testing in NSCLC patients; 2.

Aims To investigate whether a ‘CT first’ approach to Rapid Access Lung Cancer Clinic (RALC) review could be feasible in an Irish context. Methods A retrospective review of our institution’s Lung Cancer Database was performed. All RALC first attendances from 2012-2018 were identified. Timing of CT was assessed as well as CT imaging findings. Results Total first attendances in this period were 2372, of whom 91% had CT thorax as part of their evaluation. 866 patients (37%) were diagnosed with lung cancer, all had an abnormal CT. 1290 patients (54%) underwent CT but did not have lung cancer after clinical work up. 34% of patients diagnosed with Lung Cancer had their CT scan post RALC. Time to diagnosis was longer in those who had post RALC CT (34.5 versus 21 days) Conclusion CT scanning plays a vital role in the RALC pathway. Initial delays in obtaining CT can result in delayed time to diagnosis. These findings warrant close consideration when devising future national lung cancer policy.