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Biomarker Testing for Non-Small Cell Lung Cancer in Community Practices Operated by an Academic Cancer Center.

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Summary

Biomarker testing for non-small cell lung cancer (NSCLC) is generally guideline-concordant at community practice sites. However, testing for rare biomarkers needs faster integration into clinical practice.

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Area of Science:

  • Oncology
  • Genomics
  • Clinical Practice

Background:

  • Targeted therapy has revolutionized non-small cell lung cancer (NSCLC) treatment.
  • Guideline-directed biomarker testing is crucial for treatment decisions in NSCLC.
  • Comprehensive biomarker testing rates are high in academic centers, but less is known about community practices.

Purpose of the Study:

  • To evaluate guideline-concordant biomarker testing rates for advanced, nonsquamous NSCLC patients at Dana-Farber Cancer Institute (DFCI) regional practice sites.
  • To assess the patterns of biomarker testing in academically affiliated community practice settings.

Main Methods:

  • Retrospective review of medical records for advanced NSCLC patients treated with palliative-intent therapy at DFCI regional sites (2018-2021).
  • Collected data included patient demographics, cancer histology, biomarker testing (EGFR, ALK, ROS1, MET, BRAF, RET, NTRK, KRAS, PD-L1), and treatment.
  • Assessed rates of next-generation sequencing (NGS) testing.

Main Results:

  • Among 416 patients with nonsquamous NSCLC, EGFR, ALK, and PD-L1 testing exceeded 85%.
  • KRAS, BRAF, and MET testing ranged from 55% to 71%; 45% did not receive NGS testing.
  • NGS testing for squamous NSCLC increased from 14% (2018) to 61% (2021).
  • EGFR (14%) and KRAS (37%) mutations were most frequent; targeted therapies were administered in 67% of EGFR-mutant and 69% of ALK-rearranged cases.

Conclusions:

  • Most patients, particularly those with nonsquamous NSCLC, received guideline-concordant biomarker testing at DFCI regional sites.
  • Testing for rare biomarkers with recently approved targeted therapies lagged behind established biomarkers.
  • Highlights the need for rapid integration of novel biomarker testing into clinical practice.