Highlights
- •This real-world study evaluated biomarker testing and targeted therapy in mNSCLC
- •At least one biomarker test was received by 89.4% of patients with mNSCLC
- •Targeted therapy was used in 62.4% of patients with a positive biomarker test
- •Increases in biomarker testing were observed after national guideline updates
- •Despite recent improvements, there remain gaps in biomarker testing and treatment
ABSTRACT
Purpose
: This study was designed to describe real-world changes in biomarker testing among
patients with non-squamous, metastatic non-small-cell lung cancer (mNSCLC) in a community
oncology setting from 2015 to 2020.
Patients and Methods
: This retrospective study randomly selected 500 adult patients diagnosed with non-squamous
mNSCLC to undergo chart review and data extraction. Data were extracted and validated
by two independent abstractors. Biomarker testing rates were described before and
after national guideline updates and FDA approval of targeted agents.
Results
: At least one biomarker test was received by 89.4% of patients with mNSCLC. Of all
patients, 46.6%, 34.6%, and 8.2% received both single-gene and next generation sequencing
(NGS)-based testing, single-gene testing only, and NGS-based testing only, respectively.
However, there were changes in testing rates at the time of drug approvals for targeted
agents. Biomarker testing increased for ALK (45.0% before to 78.3% after ALK-targeted
drug approval), BRAF (20.0% to 67.8%), EGFR (20.0% to 78.2%), NTRK (34.6% to 55.7%),
and ROS1 (29.6% to 74.2%). Biomarker testing increased after changes were made to
national guidelines for BRAF (from 18.8% before to 68.1% after inclusion in guidelines),
NTRK (37.2% to 56.5%), and ROS1 (40.8% to 74.5%). Targeted therapy was used in 62.4%
of patients with a positive biomarker.
Conclusion
: Increases in biomarker testing rates were observed relative to targeted agent approvals
and national guideline updates. However, many patients with non-squamous mNSCLC did
not receive full genotyping in accordance with national guidelines and represent an
opportunity to identify reasons and solutions for barriers to care.
Microabstract
: This real-world chart review study observed increases in biomarker testing after
both targeted drug approvals and after inclusion in national treatment guidelines.
Despite these improvements, approximately 10% of patients never received any biomarker
testing, and more than one third of patients with positive biomarker tests do not
receive targeted therapy. Further work is needed to understand barriers in patient
care.
Keywords
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Article info
Publication history
Accepted:
March 2,
2023
Received in revised form:
February 28,
2023
Received:
October 4,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc.
