Molecular Testing Rate for Patients with Non–Small-Cell Lung Cancer Remains Low

Precision medicine has changed oncology practice from a one-size-fits-all approach to tailored treatment based on genomic variants.¹ This approach has transformed cancer care by identifying key drivers of oncogenesis that can be targeted by specific therapies. A targeted treatment approach can improve clinical outcomes for patients by providing clinically important diagnostic and prognostic information.¹

Lung cancer is the most common cause of cancer-related mortality worldwide, with most cases being diagnosed at advanced stages.² Even at advanced stages, there are targeted treatments available. For example, the National Comprehensive Cancer Network recommends crizotinib for the treatment of cancer that tests positive for ALK and erlotinib for the first-line treatment of EGFR mutation.² However, despite the importance of using molecular testing, routine uptake is variable. Some barriers to ordering mutation testing include a lack of tissue to test and wait time for results.² Another barrier can be coordination of care concerns.²

To evaluate the factors that contribute to molecular testing and treatment patterns in patients with lung cancer, Behera and associates used the American Society of Clinical Oncology CancerLinQ Discovery data set to identify patients who were diagnosed with lung cancer between 2010 and 2018. The study’s primary outcome was whether molecular testing was performed.

The study analyzed data from 37,925 patients with stage 4 non–small-cell lung cancer. The median patient age was 65 years, 68% of patients were white, and 51% were male. Adenocarcinoma was the histology type for 33.5% of patients, and approximately 22% of all patients had molecular testing results.

For patients with adenocarcinoma, molecular test results were available for 49%. Further analysis found that female patients were more likely than male patients to have had molecular testing. Black patients were less likely than white patients to have had molecular testing, and Asian patients were more likely than white patients to have had molecular testing. Hispanic patients were found to be more likely to have had molecular testing performed than non-Hispanic patients.

Molecular testing was associated with a significantly higher likelihood of having treatment with immunotherapy and targeted therapy.

References:

1. Malone ER, Oliva M, Sabatini PJB, Stockley TL, Siu LL. Molecular profiling for precision cancer therapies. Genome Med. 2020;12(1):8.
2. Arney J, Helm A, Braun UK, Chen GJ, Hayes TG. Barriers and facilitators to the use of genomic-based targeted lung cancer therapies in the VA: qualitative findings. Fed Pract. 2018;35(suppl 1):S53-S57.

Source: Behera M, Joseph G, Rupji M, et al. Molecular testing and patterns of treatment in patients with NSCLC: an IASLC analysis of ASCO CancerLinQ Discovery data. J Clin Oncol. 2022;40(suppl 16):S9128.