Background: Patients with advanced non-small cell lung cancer (aNSCLC) are recommended to undergo molecular testing to identify predictive and prognostic genomic alterations. Despite this, there are gaps in patients receiving appropriate targeted therapy, which may be related to testing turn-around time (TAT). Expert guidelines recommend TAT of 2 weeks for ALK/EGFR alterations, two prevalent driver mutations with highly effective targeted therapies. Patients & Methods: Using the Flatiron Health electronic health record-derived, deidentified database, we conducted a retrospective cohort study of United States (US) patients with aNSCLC diagnosed from 2013 to 2023 and receiving testing for at least one of eight key molecular markers. We assessed patterns overtime, including biomarkers tested per patient, testing modality, and TAT (defined as time between specimen collection and result date). We also assessed patients with aNSCLC harboring ALK and EGFR alterations (ALK+/EGFR+) who initiated empiric treatment prior to test result availability, including patient characteristics, clinical outcomes, and association with TAT. Results: There were 33,945 patients in our sample (mean age 68.2 years, 49.4% female, 58.3% White race, 83.4% with history of smoking). Biomarker testing increased overtime (2.0/patient 2011, to 6.8/patient 2023), and half of patients received testing for all biomarkers in 2023. Use of next-generation sequencing (NGS) increased overtime, corresponding to a convergence of TAT for all biomarkers to 3 weeks by 2023. One in eight patients with ALK+/EGFR+ aNSCLC initiated empiric non-targeted treatment prior to testing result date, and a quarter of these patients received immunotherapy. TAT predicted early empiric initiation of treatment (Figure) in patients with ALK+/EGFR+ aNSCLC, both as a continuous (OR 1.09, p < .001) and binary variable (TAT 0–2 versus >2 weeks, OR 6.02, p < .001). Early empiric treatment was associated with worse median progression-free survival compared to waiting for test results to initiate treatment (9 versus 11 months, p < .05 by log-rank test). Discussion & Conclusions: Biomarker testing, especially with NGS, has increased overtime in US patients with aNSCLC. TAT has stagnated and remains suboptimal compared to consensus guidelines. Longer TAT predicted early non-targeted treatments for patients with ALK+/EGFR+ aNSCLC, resulting in suboptimal first-line treatment and corresponding to worse clinical outcomes.
BPI25-005: Figure 1. Distribution of Patients with ALK+/EGFR+ aNSCLC by Treatment Prior vs After Test Result Date, by Turn-Around Time Week. *Masked values given subgroups of 5 or fewer patients.
Citation: Journal of the National Comprehensive Cancer Network 23, 3.5; 10.6004/jnccn.2024.7178
