Developments in predictive biomarker testing and targeted therapy in advanced stage non-small cell lung cancer and their application across European countries

Vincent D de Jager ¹, Wim Timens ¹, Arnaud Bayle ²

¹Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
²Oncostat U1018, Inserm, Paris-Saclay University, Gustave Roussy, Villejuif, France.
³Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy of University of Gothenburg, Gothenburg, Sweden.
⁴Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
⁵Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany.
⁶Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
⁷Charles University and Thomayer Hospital, Prague, Czech Republic.
⁸Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria.
⁹Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria.
¹⁰IHU RespirERA, FHU OncoAge, Nice University Hospital, Côte d'Azur University, Nice, France.
¹¹Department of Oncology, University Hospital Antwerp, University of Antwerp, Edegem, Belgium.
¹²Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
¹³Department of Pathology, University Hospital Antwerp, University of Antwerp, Edegem, Belgium.
¹⁴Laboratory for Cytology and Pathology, University Clinic Golnik, Golnik, Slovenia.
¹⁵Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Research Institute Hospital 12 de Octubre (i+12), Ciberonc, Madrid, Spain.
¹⁶National Disease Registration Service, NHS England, London, United Kingdom.
¹⁷Centre for Cancer, Society & Public Health, King's College London, London, United Kingdom.
¹⁸Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.
¹⁹Faculty of Medicine of the University of Porto, Institute for Research and Innovation in Health (i3S), Porto, Portugal.
²⁰University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.
²¹Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, H12O-CNIO Lung Cancer Clinical Research Unit, Research Institute Hospital 12 de Octubre (i+12)/Spanish National Cancer Research Center (CNIO), Ciberonc, Madrid, Spain.
²²Lung Unit, Royal Marsden NHS Trust, London, United Kingdom.
²³The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, Czech Republic.
²⁴Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
²⁵Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.
²⁶Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

⁰Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

The Lancet Regional Health. Europe +

|

March 13, 2024

View abstract on PubMed

Summary

Targeted therapies and immunotherapy have transformed metastatic non-small cell lung cancer (NSCLC) treatment. While guidelines exist for predictive testing in Europe, testing rates and targeted therapy availability vary, impacting patient care.

Area Of Science

Oncology
Molecular Diagnostics
Public Health

Background

Metastatic non-small cell lung cancer (NSCLC) treatment has evolved with targeted therapies and immunotherapy.
Predictive molecular testing is crucial for identifying patients eligible for targeted treatments.
This review examines targeted therapy and biomarker testing in advanced NSCLC across Europe.

Purpose Of The Study

To review the development and current use of targeted therapies and predictive biomarker testing in European patients with advanced NSCLC.
To assess the integration of predictive testing recommendations into national guidelines.
To evaluate the availability of EMA-approved targeted therapies and the status of molecular testing rates.

Main Methods

Review of national guidelines and data from eleven European countries.
Analysis of the availability of targeted therapies approved by the European Medicines Agency (EMA).
Assessment of the implementation and guidelines for Molecular Tumor Boards (MTBs).

Main Results

Predictive testing recommendations are in European guidelines, but comprehensiveness varies.
Availability of EMA-approved targeted therapies differs across European countries.
Routine assessment of molecular testing rates is limited, leaving the proportion of adequately tested patients uncertain.
Molecular Tumor Boards are common, but national guidelines for their structure and function are absent.

Conclusions

While guidelines for predictive testing in advanced NSCLC exist in Europe, disparities in implementation and therapy availability persist.
There is a need for better assessment of molecular testing rates to ensure equitable patient access to targeted treatments.
Establishing national guidelines for Molecular Tumor Boards is essential for consistent interpretation of complex mutations and quality control in treatment decisions.

Keywords:

Europe Non-small cell lung cancer Predictive biomarker testing Targeted therapy

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