Adherence to the National Comprehensive Cancer Network (NCCN) guideline for biomarker testing for non-squamous advanced non-small cell lung cancer (NSCLC) is associated with decreased risk of mortality, according to a recent study.
Identification of molecular alterations is critical for optimal management of advanced NSCLC. The NCCN guideline recommends molecular diagnostic testing in the pathologic evaluation for non-squamous advanced NSCLC. However, many patients are not tested in routine oncology practice.
Ani John, BSN, MPH, PhD, Roche Diagnostics (Pleasanton, CA), and colleagues designed a study to examine the impact of adherence to testing on real-world patient outcomes. A total of 29,658 patients diagnosed with stage IIIB or higher, non-squamous advanced NSCLC between 2011 and 2019 from the de-identified nationwide Flatiron Health EHR-derived database were included in the analysis.
Testing status was predefined as those with any of the NCCN recommended molecular tests (EGFR, ALK, ROS1, KRAS, BRAF, or PD-L1) any time between 14 days prior to and 90 days after diagnosis date, or those who did not have documentation of receipt of any of the mentioned tests during this time period. Among the patient sample, 75.3% were tested and 24.7% had no evidence of testing.
Results of the analysis were published in JNCCN (online March 20, 2020; doi:10.6004/jnccn.2019.7441).
Dr John and colleagues noted that 90% of patients were from community clinics and 31% of patients had commercial health insurance.
Patients with no evidence of testing were less likely to be enrolled in a commercial health plan, more likely to have a history of smoking, and more likely to be diagnosed before 2013 compared with tested patients (P < .05).
Additionally, researchers found that tested patients had a lower risk of mortality in an unadjusted analysis (HR, 0.84; 95% CI, 0.82-0.87) and lived longer compared with patients with no evidence of testing (median survival 17.1 vs 13.8 months, respectively). This association remained significant after adjusting for potential confounders such as age at diagnosis, sex, history of smoking, initial stage at diagnosis, race, and year of advanced diagnosis (HR, 0.77; 95% CI, 0.74-0.79).
“Results from this study reaffirm the value of individual biomarker testing for treatment selection, and also demonstrates that a precision medicine approach supported by NCCN guidelines should be integral to the management of patients with advanced NSCLC,” authors of the study concluded.—Zachary Bessette
