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Biomarker Testing Is Underutilized Prior to Frontline Testing in Patients with NSCLC

Lung Cancer Monthly Minutes - Lung Cancer

Lung cancer is the leading cause of cancer deaths globally, and non–small-cell lung cancer (NSCLC) accounts for 85% of lung cancer cases in the United States.1 A majority of patients with NSCLC are diagnosed in the advanced stage, which has a poor prognosis and a 5-year survival rate of 6.3%.1 Despite this, targeted therapies based on gene mutations found in advanced NSCLC have decreased incidence-based mortality and increased disease-specific survival over the past decade.1 Current guidelines recommend molecular testing for all patients with advanced NSCLC, including mutations for programmed death ligand 1 (PD-L1) overexpression, anaplastic lymphoma kinase (ALK), epidermal growth factor receptor (EGFR), BRAF mutation, ROS1 gene rearrangement, neurotrophic tyrosine receptor kinase (NTRK), MET, and RET in patients with nonsquamous NSCLC and to consider testing for these biomarkers in patients with squamous histology.1 Despite these guidelines for testing, studies have found that patients with advanced NSCLC receive varying rates of biomarker testing.1

At the 2021 American Society of Clinical Oncology annual meeting, researchers presented the results of a retrospective study of real-world patterns of biomarker testing and targeted therapy in 3213 adult patients with metastatic NSCLC seeking treatment in the community oncology setting.2 As most of the biomarker-guided therapies gained approval after 2016, patient testing patterns (N = 2257) were described in this study for 2017 to 2019.2 The majority (60%) of the patients had adenocarcinoma and 16% had squamous-cell carcinoma.2 The remainder had other or unknown cancer histology.2 The median patient age was 68 years.2 Of these patients, 52.7% were male and 10% were current smokers.2 The Eastern Cooperative Oncology Group performance status score was 0 to 1 in 55.2% of patients.2

Study results revealed that 23.6% of the patients were not tested for any biomarker at any time during the study period and 49% had a biomarker test result prior to frontline treatment.2 For patients with positive PD-L1 (586 patients), 516 had their test results prior to frontline treatment and 394 patients received a PD-L1 inhibitor as frontline treatment.2 There were 42 patients who were ALK positive, but only 5 had test results prior to frontline treatment with 3 receiving an ALK inhibitor as their frontline treatment.2 EGFR biomarker was found in 503 patients with 203 of these patients having their test results prior to frontline treatment and only 33 receiving an EGFR inhibitor as frontline treatment.2 BRAF mutation was found in 25 patients, with 10 having results prior to frontline treatment and no patients receiving BRAF inhibiting treatment.2 ROS1 was found in 15 patients.2 Of these patients, only 6 had results prior to frontline treatment and only 1 had ROS1 inhibiting frontline treatment.2

Despite recommendations for testing for biomarkers to determine the most effective frontline treatment in the community oncology setting, there appears to be a lack of adequate biomarker testing prior to initiating therapy.

References

  1. Waterhouse DM, Tseng WY, Espirito JL, Robert NJ. Understanding contemporary molecular biomarker testing rates and trends for metastatic NSCLC among community oncologists. Clin Lung Cancer. 2021;S1525-7304(21)00100-5.
  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(15_suppl):9079-9079.
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Last modified: August 23, 2021