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J. Yi



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    P3.01 - Advanced NSCLC (ID 621)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P3.01-086 - Biomarker Testing Trends and Treatment Patterns in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients in the United States (ID 9098)

      09:30 - 09:30  |  Author(s): J. Yi

      • Abstract

      Background:
      The CAP/IASLC/AMP molecular testing guidelines recommend ALK and EGFR testing on patients with lung adenocarcinoma, regardless of clinical characteristics. While PD-L1 testing has recently become available, a potential challenge to implement this testing is limited tissue availability. NGS may address this issue but there are limited published data assessing the impact of PD-L1 testing on NSCLC biomarker testing and treatment patterns using large real-world data sources. The objective of this study is to describe real-world biomarker testing and treatment patterns in the United States (US).

      Method:
      Flatiron Health’s database is a longitudinal, demographically and geographically diverse database containing EHR data. The database includes over 265 cancer clinics (~800 sites of care) representing more than 1.7 million active US cancer patients. Patients with ≥2 visits after Jan 1, 2011, ≥18 years of age, treated in first line (1L), and stage IIIB/IV NSCLC diagnosis from Jan 2012 - Mar 2017 were included in this analysis. Results were stratified by year of diagnosis (2012-2015 vs. 2016+).

      Result:
      Of 21,514 patients identified, the majority (80%) were diagnosed with de novo disease and 76% presented with non-squamous histology. PD-L1 testing rates were higher in those diagnosed in 2016+ compared to 2012-2015 (36% vs. 7%). A larger proportion of patients were tested for at least one biomarker in 2016+ (75%) vs. 2012-2015 (65%). The use of NGS also doubled (10% in 2012-2015 vs. 21% in 2016+) during this time period. For all patients, biomarker positivity rates varied by biomarker (PD-L1: 34%, EGFR: 17%, ALK: 4%, ROS1: 2%, KRAS: 30%) and by histology with the exception of PD-L1. The percentage of patients who initiated 1L systemic therapy, prior to receiving their first positive biomarker test results, ranged from 17% to 27% depending on the biomarker test.

      Conclusion:
      The introduction of PD-L1 testing has coincided with an increase in the proportion of patients being tested for a biomarker, as well as an increase in NGS. NGS has previously been shown to be associated with the longest turn-around time, and up to 27% of patients initiate systemic therapy prior to receiving positive biomarker test results. Additional research to understand the resource implications and clinical outcomes of initiating systemic therapy prior to test results (rather than delaying therapy) is underway.