Loading ...

TOPLINE:

In patients with advanced non–small cell lung cancer (NSCLC), first-line treatment choices based on biomarker testing lead to better patient outcomes, according to new findings that reinforce existing guidelines that recommend comprehensive genomic profiling before treatment in this population.

METHODOLOGY:

• In patients diagnosed with advanced NSCLC, biomarker testing for ALK and EGFR before starting immunotherapy remains underused despite guideline recommendations. Forgoing biomarker testing in this population may mean patients are not benefiting from precision oncology and end up receiving suboptimal care.
• In the current study, researchers assessed outcomes among patients who received optimal first-line treatment according to biomarker test results. Researchers analyzed a dataset of 359 eligible US patients who had their first claim mentioning advanced or metastatic NSCLC between March 2019 and February 2020 and had ALK rearrangement or EGFR mutation detected by comprehensive genomic profiling between June 2014 and March 2022.
• According to National Comprehensive Cancer Network guidelines, 78% of patients (280 of 359) received optimal therapy and 22% (79 of 359) received suboptimal treatment.
• The study compared real-world time with next treatment, time to discontinuation, and healthcare utilization in emergency department, inpatient, and outpatient settings between the two groups.

TAKEAWAY:

• In the optimal group, 53.6% underwent comprehensive genomic profiling tests before initiating first-line therapy compared with 20.3% in the suboptimal group (P < .0001).
• The median time to the next treatment was significantly longer among patients receiving optimal first-line therapy (11.2 vs 4.4 months).
• Patients in the optimal group also had a significantly longer median time to treatment discontinuation (10.4 vs 1.9 months) and required fewer emergency department (0.76 vs 1.27) and outpatient visits (22.9 vs 42.7) than the suboptimal group.
• The suboptimal group had higher rates of neutropenia, tinnitus, and pneumonitis in the 12 months following therapy initiation.

IN PRACTICE:

"These findings suggest that treatment concordant with [comprehensive genomic profiling] findings is associated with better health outcomes" and provide further support for the American Society of Clinical Oncology and National Comprehensive Cancer Network recommendations that NSCLC treatment decisions should be tailored to a patient's biomarkers, the authors concluded.

SOURCE:

This study, led by Adam C. Powell, PhD, from Payer+Provider Syndicate, Newton, Massachusetts, was published online on January 8 in the Journal of the National Comprehensive Cancer Network.

LIMITATIONS:

Patient medical records were not available, and patients were not categorized by disease stage or subtype. Moreover, inaccuracies in diagnosis codes on claims might have occurred, and the reasons for receiving suboptimal treatments were not known.

DISCLOSURES:

The study funding source was not disclosed. Powell reported being employed by and owning Payer+Provider Syndicate. Other authors were employed by and stockholders in Guardant Health.