Patterns of Biomarker Testing in Metastatic NSCLC in the Community Oncology Setting

Lung and bronchus cancer was the second most frequent cancer form in 2017, accounting for 13% of all new cancer cases in the United States.¹ Non–small-cell lung cancer (NSCLC) accounted for approximately 80% to 85% of the estimated 222,550 lung and bronchus cancer cases reported in 2017.¹ The majority of people with NSCLC are diagnosed when it has progressed to the stage of metastatic disease.¹

In metastatic NSCLC, national recommendations advocate biomarker testing, and targeted therapy is linked to better results.² There is evidence that predictive biomarker testing and subsequent first-line targeted therapy treatment in patients with NSCLC has not been widely adopted in the clinical context, despite clear therapeutic benefit and guideline recommendations.¹

The US Oncology Network structured electronic health records data were used to conduct a retrospective analysis of adult patients diagnosed with de novo metastatic NSCLC between January 1, 2016, and September 30, 2019, with follow-up through December 31, 2019.² Patients with metastatic NSCLC who underwent systemic treatment were included in the study.²

Overall, 23.6% of participants were never tested for a biomarker (PD-L1 or driver mutation) during the study, and only 49% got a biomarker test result prior to receiving first-line therapy.² When assessing driver mutation specifically, similar patterns were found: 35.8% had never been tested for driver mutation, and only 39.3% had a driver mutation test result prior to first-line therapy.²

Despite the availability of promising biomarker-based treatments, insufficient testing in the community oncology context implies that not all eligible patients receive the most effective therapies right away.² In this metastatic NSCLC cohort (all histologies), >61% had no driver mutation test reported before first-line treatment, and some were later found to be driver mutation–positive, emphasizing a wasted chance to use the most effective biomarker-directed frontline treatment.²

Providers have considerable hurdles due to rapidly changing recommendations and growing understanding of many actionable biomarkers in cancer care.¹ Advances in NSCLC diagnosis and treatment are important to increasing survival rates.¹ Compared with traditional cytotoxic chemotherapies, the recent identification of some of the driver mutations for NSCLC has enabled more choices for personalized targeted treatment.¹ As a result, routine molecular testing for the detection of specific known genetic anomalies is now a standard guideline for patients with advanced NSCLC.¹

References

1. Mason C, Ellis PG, Lokay K, et al. Patterns of biomarker testing rates and appropriate use of targeted therapy in the first-line, metastatic non-small cell lung cancer treatment setting. J Clin Pathw. 2018;4:49-54.
2. Nadler ES, Vasudevan A, Davies K, et al. Real-world patterns of biomarker testing and targeted therapy in metastatic non-small cell lung cancer (mNSCLC) in the community oncology setting. J Clin Oncol. 2021;39(suppl 15):Abstract 9079.