Abstract
Background
Despite recommendations for molecular testing irrespective of patient characteristics,
differences exist in receipt of molecular testing for oncogenic drivers amongst metastatic
non-small cell lung cancer (mNSCLC) patients. Exploration into these differences and
their effects on treatment is needed to identify opportunities for improvement.
Methods
We conducted a retrospective cohort study of adult patients diagnosed with mNSCLC
between 2011 and 2018 using PCORnet's Rapid Cycle Research Project dataset (n=3,600).
Log-binomial, Cox proportional hazards (PH), and time-varying Cox regression models
were used to ascertain whether molecular testing was received, and time from diagnosis
to molecular testing and/or initial systemic treatment in the context of patient age,
sex, race/ethnicity, and multiple comorbidities status.
Results
The majority of patients in this cohort were ≤ 65 years of age (median [25th, 75th]: 64 [57, 71]), male (54.3%), non-Hispanic white individuals (81.6%), with >2 comorbidities
in addition to mNSCLC (54.1%). About half the cohort received molecular testing (49.9%).
Patients who received molecular testing had a 59% higher probability of initial systemic
treatment than patients who were yet to receive testing. Multiple comorbidity status
was positively associated with receipt of molecular testing (RR, 1.27; 95% CI 1.08,
1.49).
Conclusion
Receipt of molecular testing in academic centers was associated with earlier initiation
of systemic treatment. This finding underscores the need to increase molecular testing
rates amongst mNSCLC patients during a clinically relevant period. Further studies
to validate these findings in community centers are warranted.
Micro-abstract
Molecular testing rates remain low among metastatic non-small cell lung cancer (mNSCLC)
patients. This may relate to concern that testing could delay systemic treatment initiation.
We studied a PCORnet multi-site retrospective cohort, and show that molecular testing
is associated with earlier systematic treatment initiation. Strategies increasing
molecular testing in mNSCLC should be employed without fear of treatment delay.
Keywords
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Article info
Publication history
Accepted:
March 10,
2023
Received in revised form:
February 13,
2023
Received:
October 21,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This research was supported by internal funding
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
