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Biomarker testing for advanced non-small cell lung cancer (NSCLC) is suboptimal, with significant physician variation. Testing, including anaplastic lymphoma kinase (ALK), epidermal growth factor receptor (EGFR), and PD-L1, correlates with improved survival outcomes.

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Area of Science:

  • Oncology
  • Clinical Research
  • Biomarker Discovery

Background:

  • Advanced non-small cell lung cancer (NSCLC) requires comprehensive biomarker testing.
  • Anaplastic lymphoma kinase (ALK), epidermal growth factor receptor (EGFR), and PD-L1 testing are crucial for targeted therapy and immune checkpoint inhibitor selection.
  • Real-world data on testing patterns and their clinical impact are essential.

Purpose of the Study:

  • To analyze real-world patterns of biomarker testing in advanced NSCLC.
  • To quantify interphysician variation in ordering ALK, EGFR, and PD-L1 tests.
  • To correlate biomarker testing with clinical outcomes in NSCLC patients.

Main Methods:

  • Retrospective analysis of deidentified electronic health record data from 17,165 advanced NSCLC patients (2018-2021).
  • Descriptive analyses, logistic regression, and proportional hazard models were employed.
  • Focus on community-based care settings.

Main Results:

  • Only 67% of all patients and 77% with nonsquamous metastatic NSCLC received ALK, EGFR, and PD-L1 testing within 90 days.
  • Later diagnosis years and nonsquamous histology were associated with higher testing rates.
  • Testing all three biomarkers significantly prolonged survival (median 364 days vs. 180 days).

Conclusions:

  • Biomarker testing rates for advanced NSCLC remain suboptimal.
  • Substantial interphysician variation in testing practices was observed.
  • While causality is unproven, biomarker testing correlates with improved patient survival.