Photo Credit: ArtemisDiana
Biomarker tests for non-small lung cancer (NSCLC) improve patient outcomes, but they are not available to everyone.
An industry-sponsored study suggests that clinicians vary in the reasons they order biomarker tests that benefit patients with non-small lung cancer (NSCLC).
“Results from this study indicate that physicians’ approach to biomarker testing is evolving towards more routine procedures, rather than testing to inform a specific treatment decision, marked by a recorded increase in reflex and broader panel-based testing,” Ayse Levent, MSc, and Pieter De Richter wrote in their abstract presented at the 2024 ASCO Annual Meeting in Journal of Clinical Oncology.
The researchers used the online syndicated patient-record database MDx Monitor to explore the factors influencing decisions to test for biomarkers in the United States in 2021, 2022, and 2023. Over those years, physicians who treated cancer submitted data from 414 NSCLC patients tested for biomarkers, and the authors compiled the reasons physicians provided for ordering tests.
The top reasons for biomarker testing they found in all NSCLC stages in 2021, 2022, and 2023, respectively, were:
- Standard procedure to test for this marker: 62%, 80%, 87%;
- Histology or patient type: 20%, 16%, 18%;
- Inform treatment decision: 36%, 27%, 18%;
- Patient request: 9%, 16%, 13%;
- Biomarker tested as part of wider panel, not specifically ordered: 6%, 5%, 11%; and
- Reflex test performed by pathologist or lab: 2%, 3%, 18%.
“Although guidelines focus on assessing metastatic patients’ eligibility for targeted therapies, early-stage patients also stand to benefit from more automated testing processes,” the researchers concluded. “Further investigation on time between diagnosis and implementation of biomarker testing, along with subsequent treatment outcomes, is warranted.”
Is Biomarker Testing Underutilized?
In related industry-sponsored research presented at the 2024 ASCO Annual Meeting, Vernon Videna, PharmD, RPh, and colleagues demonstrated the need for increased biomarker testing.
“These findings suggest that biomarker testing may be underutilized and that many patients may not be benefitting from treatment with precision therapies,” the researchers wrote in their abstract and in Journal of Clinical Oncology. “Among patients with confirmed actionable mutations, many are not receiving the appropriately targeted therapy,” they added in their poster.
The authors noted that biomarker testing is a valuable tool for identifying patients who are likely to benefit from targeted therapy. However, guideline-recommended biomarker testing in patients with advanced NSCLC is inconsistent.
In their retrospective analysis of biomarker testing rates in US patients with NSCLC between 2003 and 2023, Dr. Videna’s research team used natural language processing (NLP) to search and analyze the real-world Amplity Insights database of transcribed, de-identified patient medical records of physician-patient interactions. The mean age of the 61,018 patients in all NSCLC stages was 69.8 years; 50.6% were female, and 87.9% were White.
Overall:
- 4% of patients in all NSCLC stages showed evidence of biomarker testing.
- 8% of the 23,845 patients seen by an oncologist showed evidence of biomarker testing.
- 9% of the 6,387 patients with an identified mutation received an appropriately matched targeted therapy, and 10.1% received a non-indicated targeted therapy.
“Regional differences in biomarker testing rates were observed, suggesting that other factors, such as social determinants, likely influence access to biomarker testing,” the authors wrote.
“Despite having confirmed actionable mutations, patients are not receiving the appropriate targeted therapy, even when only oncology transcription records are considered … suggesting that there is an urgent need for additional educational strategies to optimize the adoption of precision oncology and elevate patient outcomes,” they concluded.
