What criteria should I use to refer patients for immunotherapy evaluation in a primary care setting?

In a primary care setting, the criteria for referring patients for immunotherapy evaluation primarily involve identifying patients with confirmed or suspected cancers that may benefit from systemic anti-cancer therapies, including immunotherapy. Referral should be considered when patients have a diagnosis of cancers such as non-small-cell lung cancer (NSCLC) with specific molecular markers (e.g., NTRK fusion positive, KRAS G12C positive, METex14 skipping alteration, BRAF V600 positive) and PD-L1 expression status, as these factors influence eligibility for immunotherapy treatment options. Additionally, patients presenting with symptoms or signs suggestive of cancer requiring urgent investigation or specialist assessment should be referred promptly to secondary care or multidisciplinary teams (MDTs) for further evaluation, which may include immunotherapy consideration. Primary care clinicians should also consider urgent referral pathways for patients with suspected cancer based on symptom criteria outlined in NICE guidelines, as early diagnosis and specialist assessment are critical for timely immunotherapy evaluation and treatment initiation.

Key referral criteria include:

• Confirmed diagnosis of cancers with actionable molecular markers relevant to immunotherapy (e.g., NSCLC with NTRK fusion, KRAS G12C, METex14 skipping, BRAF V600 mutations) and PD-L1 expression assessment.
• Presentation with symptoms or signs strongly suggestive of cancer warranting urgent investigation or referral under suspected cancer pathways.
• Referral to appropriate MDTs for patients with metastatic disease or unknown primary cancers for comprehensive evaluation including systemic therapy options.

These criteria ensure patients who may benefit from immunotherapy are identified early and referred appropriately for specialist assessment and treatment planning.

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