Biomarker testing for patients with non–small-cell lung cancer (NSCLC) is recommended by the National Comprehensive Cancer Network (NCCN) guidelines prior to treatment commencement. Testing has been demonstrated to improve patient outcomes with a lower mortality risk and longer median overall survival found in patients who had NCCN guideline-recommended biomarker assessment. This also holds true for patients with metastatic NSCLC, with 5-year survival rates for patients who receive targeted therapy or immunotherapy having a 15% to 63% survival rate compared with a 6% survival rate for patients receiving cytotoxic chemotherapy. It is estimated that approximately 70% of patients with NSCLC in the United States receive biomarker testing for ALK, EGFR, and/or ROS1 mutations, but rates for comprehensive testing is unknown.
To understand US oncologist biomarker testing practices, an American Society of Clinical Oncology taskforce performed a survey of 2374 physicians, nurse practitioners, and physician assistants in oncology practice. In addition to ordering practices, the types of testing platforms, barriers to testing, and the impact of testing delays on treatment decisions were also assessed.
The taskforce consisted of members of the American Cancer Society, LUNGevity, National Lung Cancer Roundtable, the GO2 Foundation for Lung Cancer, the ROS1ders, and representatives from academic and community oncology practices. There were 170 completed surveys available for analysis. The vast majority of responses (98%) were from physicians, with an even split of practitioners who saw ≤50% of patients with lung cancer per month and physicians who saw ≥51% of patients with lung cancer per month. Academic practitioners comprised approximately 60% of respondents. The majority of respondents (68%) were responsible for ordering patient biomarker testing. The most common sampling methods were endobronchial ultrasound-guided transbronchial needle aspiration (47%) and percutaneous biopsy performed by interventional radiologists (31%). Multigene panels were used by 93% of respondents over single-gene panels. Biomarker testing for EGFR, ALK, ROS1, and BRAF was performed by 97% of respondents while testing for MET, RET, and NTRK was higher in academic providers and thoracic oncologists than community providers and generalists. When turnaround survey responses were analyzed, 98% of respondents indicated that a 1- to 2-week turnaround was acceptable, but 37% of respondents waited ≥3 weeks before results were received. For patients with non-squamous NSCLC, there were high rates of biomarker testing, with 92% tested at diagnosis and 85% at progression. With squamous NSCLC there were differences in testing between oncologists within 5 years of training and generalists who tested at a higher rate than other practitioner groups.
Analysis for barriers to biomarker testing revealed that inadequate tumor specimen was reported as a barrier by 34% of respondents, while 23% of respondents indicated that concerns about treatment delay was a reason to not order biomarker testing. Increased strategies to improve biomarker testing was reported by 71% of respondents with 85% of these indicating multidisciplinary coordination across treatment teams being the most common strategy.
Mileham KF, Schenkel C, Bruinooge SS, et al. Defining comprehensive biomarker-related testing and treatment practices for advanced non-small-cell lung cancer: results of a survey of U.S. oncologists. Cancer Med. 2022;11:530-538.