e23309 Background: Treatment recommendations for biomarker-directed therapy in advanced non-small cell lung cancer (NSCLC) are rapidly evolving, with current clinical guidelines recommending assessment of both HER2 overexpression (OE) and HER2 gene mutations. However, integrating HER2 testing into practice remains a significant challenge. To address this, we implemented a data-driven quality improvement (QI) initiative to evaluate current practices and identify opportunities to optimize HER2 testing and evidence-based care. Methods: Between August–October 2025, healthcare professionals at two academic cancer centers (aHCPs; n = 65) completed surveys and baseline patient chart audits (n = 75) to identify practice gaps. At audit-feedback (AF) sessions, aHCPs reviewed site-specific findings from the baseline assessment and developed action plans to address identified gaps, including integrating a HER2 testing resource into practice. In parallel, a nationwide survey of community HCPs (cHCPs; n = 72) was conducted to evaluate real-world practice patterns and benchmark community care against academic centers. Results: Routine assessment of HER2 was inconsistent across settings. Assessment of HER2 mutations for every patient was reported by 29% of aHCPs and 18% of cHCPs and assessment of overexpression for every patient was reported by 31% and 18%, respectively. Chart audits revealed HER2 testing was ordered on pathology requisition in 51% of cases. Among tested patients, 82% received NGS testing for mutations, while only 13% received testing by IHC for OE. Major barriers to HER2 OE testing included executing the ordering for the test (aHCPs/cHCPs: 42%/32%), limited access to testing facilities/equipment (31%/39%), and communication and/or coordination between oncology and pathology (34%/32%). Key strategies identified for improving HER2 OE testing included institutional support for reflex testing protocols (65%/49%), better electronic health record (EHR) integration with pathology (57%/53%), and integrating training or education sessions (20%/42%). Additionally, HCPs reported that shared EHR (42%/51%), reflex testing protocols (37%/47%), and dedicated liaisons or navigators (39%/28%) would most improve collaboration between oncology and pathology. Academic AF sessions resulted in action plans focused on standardizing HER2 testing protocols, enhancing multidisciplinary communication, and securing leadership support for integrated testing workflows. Conclusions: Significant gaps exist in HER2 testing in academic and community oncology settings. Targeted QI interventions addressing workflow inefficiencies, multidisciplinary coordination, and institutional infrastructure may improve implementation of comprehensive HER2 testing and delivery of evidence-based care for patients with advanced NSCLC.
McKinnon et al. (Thu,) studied this question.