Abstract
INTRODUCTION: Precision medicine has resulted in improved outcomes for non small cell lung cancer (NSCLC), whereas biomarker testing is considered critical for guiding treatment decisions for advanced-stage NSCLC, and adoption of testing in routine practice is variable. We studied the utilization of biomarker testing in advanced NSCLC.
METHODS: The American Society of Clinical Oncology (ASCO) CancerLinQ Discovery data set was queried to identify patients diagnosed with lung cancer between 2010 and 2018. Data on demographics, tumor stage, histology, and treatments were extracted, and receipt of biomarker testing was investigated as the primary outcome. Univariate association of each clinicopathological variable with the biomarker testing outcome was performed using a chi-square test for categorical variables and an analysis of variance test for numerical variables. A multivariable logistic regression analysis with backward selection at an alpha of 0.05 was reported. All analyses were conducted using SAS 9.4.
RESULTS: A total of 37,925 patients with stage IV NSCLC were analyzed. The patients had a median age of 65 years; meanwhile, 51% of the participants were male individuals, 68% were white, and 33.5% had adenocarcinoma. Approximately 22% of all patients with NSCLC had biomarker testing results. Among the patients with adenocarcinoma, 49% had biomarker testing results available. In the stage IV group, 47% were treated with chemotherapy, 16% with immunotherapy, and 3.5% with targeted therapy. On multivariable analysis, female patients were more likely to have molecular testing compared with male patients (OR = 1.29, 95% confidence interval [CI]: 1.21-1.36, p < 0.001). Compared with white patients, black patients were less likely to have biomarker testing (OR = 0.89, 95% CI: 0.81-0.97, p = 0.009), and Asians were more likely to undergo testing (OR = 2.21, 95% CI: 1.78-2.73, p < 0.001). Hispanic patients were more likely to undergo biomarker testing than non-Hispanic (OR = 1.23, 95% CI: 1.01-1.50, p = 0.03). In addition, treatment with immunotherapy (OR = 1.86, 95% CI: 1.72-2.02, p < 0.001) and targeted therapy (OR = 2.52, 95% CI: 2.21-2.88, p < 0.001) were associated with a significantly higher likelihood of having biomarker testing. These results were also confirmed in a subgroup analysis of patients with adenocarcinoma.
CONCLUSION: In this analysis of a United States-based real-world data set of patients with stage IV NSCLC, the Asian race and female sex were associated with a higher likelihood of having biomarker testing performed. The overall percentage of patients undergoing testing remained suboptimal.