Table 1

Defined consensus statements and corresponding levels of agreement

No.	Statement	Strongly agree (%)	Tend to agree (%)	Tend to disagree (%)	Strongly disagree (%)	Overall agreement (%)
Domain A: patient profile and type
1	All patients should be tested for HER2, PD-L1 and MSI-H/dMMR at the time of diagnosis	46	34	6	14	80
2	All patients considered potentially suitable for systemic therapy should be tested for HER2, PD-L1 and MSI-H/dMMR	64	26	0	10	90
Domain B: testing pathway ideals
3	There is a need for clear guidance on which stage of the pathway PD-L1 testing should be used	44	48	2	6	92
4	A centralised, testing service can provide more efficiency and quality control in the service	42	52	2	4	94
5	PD-L1 testing should be completed in advance of MDTs to inform decision-making	42	44	10	4	86
6	Ideally, testing should be conducted within the prescribing institution	24	46	26	4	70
7	Variance in the testing pathway leads to delays in patients accessing appropriate treatment	32	58	8	2	90
8	A delay in the diagnostic process may potentially prevent optimal treatment entirely if the patient’s disease worsens significantly	48	48	2	2	96
9	It would be beneficial for automatic transfer of specific tissue cores to be in place for centralised processing	38	50	10	2	88
10	Treating physicians need to be informed promptly when there is insufficient tissue to satisfy testing requirements and so re-biopsy may be indicated	66	30	2	2	96
11	Reflex testing at the point of diagnosis is more efficient than sequential testing and may reduce the time to initiation of treatment	38	44	16	2	82
12	Reflex testing at the point of diagnosis is more cost-effective than sequential testing	30	50	16	4	80
13	Reflex testing at the point of diagnosis is recommended in all patients considered potentially suitable for systemic therapy	46	46	2	6	92
Domain C: standards/benchmarks (including reference centre vs in-house testing vs regional hubs)
14	Biomarker tests should be turned around within 10 working days	42	52	2	4	94
15	Results of biomarker tests should be available no longer than five working days from the day the sample arrives at the pathology laboratory	30	48	12	10	78
16	Either in-house or outsourced, tests need to be delivered by an approved United Kingdom Accreditation Service laboratory	52	42	4	2	94
17	The process from requesting a test to receiving the results is often unduly delayed by logistical issues	32	44	20	4	76
18	All test results should be made available on a single, integrated report	50	40	8	2	90
19	All test results should be with the oncologist prior to the first consultation post diagnosis	48	38	10	4	86
20	If there is insufficient tissue for biomarker testing, this should be discussed at the MDT	48	48	2	2	96
21	Treatment should be initiated within 30 days of receiving biomarker test results	46	44	8	2	90
22	Positivity rates should be audited for the specific PD-L1 assay for comparison with literature-reported rates	42	52	4	2	94
Domain D: optimal roles and responsibilities to improve delivery of the testing pathway
23	Clearly defined roles and responsibilities for each stage in the testing pathway would benefit the efficiency	44	52	2	2	96
24	Lack of coordination between disciplines involved in the testing pathway can limit efficiency of the process	38	56	4	2	94
25	A dedicated coordinator should be in place to plan, request and coordinate dissemination of the results of tests	40	44	14	2	84
26	The MDT is responsible for ensuring that the correct testing pathway is in place	48	38	10	4	86
27	The testing pathway should have agreed and documented time and KPI targets	36	52	8	4	88
28	Testing pathway performance should be measured by the MDT	34	44	18	4	78
29	Business cases can benefit the establishment of consistent testing pathways that are efficient and accessible	38	56	4	2	94
Domain E: NHS system readiness
30	Collaborative horizon scanning between NHS and industry would be beneficial to help NHS readiness	30	68	0	2	98
31	Education of the entire MDT is vital to improve NHS system readiness for new tests and treatment modalities	54	42	2	2	96
32	Any advent of technology and testing use needs to consider capacity concerns in the NHS	50	46	2	2	96
33	Any advent of technology and testing use needs to consider resource requirements rather than just acquisition costs	46	34	6	14	94
34	NHS and NICE need to work more collaboratively so when new therapies are approved there is resource in the NHS provision for the accompanying biomarker test	64	26	0	10	98
Domain F: future considerations
35	A coordinated industry group to liaise with NHS and policymakers could help support future utilisation of new tests and modalities	44	48	2	6	92
36	Artificial intelligence technologies have the potential to improve the speed with which test results are analysed and processed	42	52	2	4	88

dMMR, mismatch repair deficiency; HER2, human epidermal growth factor receptor 2; KPI, key performance indicator; MDT, multidisciplinary team; MSI-H, microsatellite instability high; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; PD-L1, programmed death ligand 1.