Utilization Trends and Factors Associated With ROS1 Testing Among Patients With Advanced Non-small-cell Lung Cancer
William Wong1, Ning Wu1, Ravindra Gupta1
1Genentech, Inc, South San Francisco, CA.
Background:
Targeted therapy for patients with non-small-cell lung cancer (NSCLC) harboring ROS proto-oncogene 1 (ROS1) rearrangements was approved in 2016. However, little is known about real-world ROS1 testing practices in United States community practice. We aimed to characterize ROS1 testing rates and identify potential barriers to ROS1 testing.
Patients And Methods:
Flatiron Health's de-identified electronic health record-derived database was used to identify patients diagnosed with advanced NSCLC from July 2016 through December 2018 who received systemic treatment in a community practice setting. ROS1 and other biomarker testing was recorded. Regression analysis identified demographic and clinical characteristics associated with occurrence of ROS1 testing, longer time (≥ 25 days) from diagnosis to ROS1 result, and initiation of therapy prior to ROS1 result.
Results:
Among 11,409 patients, documented ROS1 testing rates increased during the study period in squamous (from 30% to 48%) and nonsquamous (63% to 78%) histologies. Patients who were older, male, black, or with squamous histology, higher Eastern Cooperative Oncology Group score, recurrent disease, or history of smoking were significantly less likely to be tested. Among patients not tested for ROS1, 63% were tested for other biomarkers. Use of next-generation sequencing, older age, Hispanic/Latino ethnicity, squamous histology, de novo disease, and smoking history predicted longer time to test result post-diagnosis. Patients with delayed results were 9.7 times more likely to receive treatment prior to ROS1 test result.
Conclusion:
In real-world practice, some patient subgroups may be less likely to receive timely ROS1 testing and to be identified for potential targeted therapy.
Insights
Real-world data shows ROS1 testing rates for non-small cell lung cancer (NSCLC) increased, but certain patient groups face delays, potentially missing targeted therapy. Further research is needed to ensure equitable testing practices.
Area of Science:
- Oncology
- Genomics
- Health Services Research
Background:
- Targeted therapy for ROS1-positive non-small cell lung cancer (NSCLC) became available in 2016.
- Real-world ROS1 testing practices in US community settings remain understudied.
- This study aimed to assess ROS1 testing rates and identify barriers in community practice.
Purpose of the Study:
- To characterize ROS1 testing rates in advanced NSCLC patients within US community practices.
- To identify demographic and clinical factors associated with ROS1 testing.
- To explore barriers to timely ROS1 testing and its impact on treatment initiation.
Main Methods:
- Utilized Flatiron Health's de-identified EHR database for advanced NSCLC patients (July 2016-Dec 2018).
- Recorded ROS1 and other biomarker testing data.
- Employed regression analysis to identify factors influencing testing rates, time to results, and pre-result treatment.
Main Results:
- ROS1 testing rates increased over the study period for both squamous and nonsquamous NSCLC.
- Older age, male sex, Black race, squamous histology, and higher ECOG score were associated with lower testing likelihood.
- Delayed ROS1 test results (≥25 days) increased the likelihood of receiving treatment before result disclosure.
Conclusions:
- Real-world ROS1 testing in community practice shows increasing rates but highlights disparities.
- Certain patient subgroups, including older, male, Black patients, and those with squamous histology, are less likely to receive timely ROS1 testing.
- Timely ROS1 testing is crucial for identifying eligible patients for targeted therapies and avoiding treatment delays.
