Medical Disclaimer
genoCDS is a clinical reference tool for qualified healthcare professionals only. Content is derived from published guidelines and regulatory sources and may contain errors or outdated information. It is not a substitute for professional medical judgment, institutional protocols, or individual patient assessment. Always verify recommendations against current primary sources before making clinical decisions. Full disclaimer →
Stage Stage IIA
Tumor >4–5 cm, no nodal or distant metastasis (T2b, N0, M0). Resectable.
2 test recommendations across 1 clinical indication
Stage IIA (T3, N0, M0) rectal cancer. MSI/MMR required for Lynch syndrome evaluation. MSI-H may qualify for neoadjuvant pembrolizumab (watch-and-wait strategy).
Required — 1 test
Microsatellite Instability / Mismatch Repair Status (MSI/MMR)
MSI/MMR
Testing for microsatellite instability (MSI) and/or mismatch repair (MMR) deficiency. Methods: PCR-based MSI testing, IHC for MMR proteins (MLH1, MSH2, MSH6, PMS2), or NGS-based MSI calculation. MSI-H (high instability) / dMMR (deficient MMR) is an FDA-approved pan-tumor biomarker for pembrolizumab and dostarlimab. MSI-H/dMMR is rare in NSCLC (<1%) but justifies routine testing given pan-tumor approval. IHC for MMR proteins can be performed on most tissue specimens.
Ordering Note
Required for all Stage II rectal cancer. MSI-H qualifies for neoadjuvant pembrolizumab; complete pathologic response rates >50% in MSI-H rectal cancer (NICHE-2). May spare surgery and radiation.
Specimen
Evidence
Recommended — 1 test
BRAF V600E Mutation Analysis
BRAF V600E
Detection of BRAF V600E (p.Val600Glu) point mutation. Dabrafenib + trametinib (Tafinlar + Mekinist) is FDA-approved for BRAF V600E-mutant metastatic NSCLC. BRAF V600E occurs in 1.5–4% of NSCLC, more commonly in adenocarcinoma, and is enriched in current/former smokers. Non-V600E BRAF mutations occur more frequently but currently lack approved targeted therapy.
Ordering Note
Recommended when MSI-H detected. BRAF V600E distinguishes sporadic MSI from Lynch syndrome.
Specimen
Evidence
Payer Coverage
Payer Coverage Summary
Coverage status as of last policy review. Prior authorization requirements and coverage criteria may change. Verify directly with each payer before ordering.
| Test | Medicare (CMS) | UnitedHealth | Anthem BCBS | Humana | Cigna | Aetna |
|---|---|---|---|---|---|---|
| MSI/MMR | Covered | Covered | Unknown | Unknown | Unknown | Unknown |
Coverage data last verified via automated policy research. Always confirm current policies with each payer.
Recommendations on this page are derived from publicly available guidelines (NCCN, ASCO, ESMO, FDA, OncoKB) and are paraphrased for reference. They do not constitute medical advice. Evidence levels reflect the grading systems of each respective organization and should be interpreted in clinical context. This reference is updated periodically but may not reflect the most recent guideline revisions.