Adherence to NCCN Guidelines for Biomarker Testing Shows Decreased Risk of Mortality for Non-Squamous aNSCLC

The NCCN guidelines recommend biomarker testing as a part of the pathologic evaluation for patients with non-squamous advanced NSCLC and NCC set out to determine how these guidelines decrease the incidence of mortality.

A study by the National Comprehensive Cancer Network (NCCN) on the clinical impact of molecular diagnostic testing for patients with non-squamous, advanced non-small cell lung cancer (NSCLC) demonstrated a decreased risk for all-cause mortality in the full cohort and a reduced risk at 1 year for patients with an initial stage IV diagnosis. There was also an increased overall survival (OS) time of patients adherent to the NCCN guidelines for testing compared with patients who were non-adherent to biomarker testing.1

The NCCN guidelines recommend biomarker testing as a part of the pathologic evaluation for patients with non-squamous advanced NSCLC, although not all patients receive this testing and are instead treated based on routine practice.2

“Results from this study reaffirm the value of individual biomarkers testing for treatment selection, and also demonstrates that a precision medicine approach supported by NCCN guidelines should be integral to the management of patients with advanced NSCLC,” the study authors wrote in their conclusion.1

Of the 2 groups that made up the full cohort, the adherent group of patients (n = 19,787) received EGFR, ALK, ROS1, BRAF, PD-L1, and KRAS testing and the non-adherent group (n = 8,997) had no evidence of biomarker testing. The OS and risk of mortality was analyzed using real-world data and additional analyses of patients with initial stage IV diagnoses. The additional analyses assessed OS truncated at 1 year.

In the full cohort, there was an 11% decreased overall risk for all-cause mortality. The hazard ratio for this cohort, after adjusting for age, sex, smoking history, and disease stage was 0.89 (95% CI, 0.86-0.92). The median OS was 15.4 months (95% CI, 15.0-15.7) in the adherent group versus 14.2 months (95% CI, 13.6-14.6). The 1-year risk for all-cause mortality, after being adjusted for age, sex, smoking, and stage, had a hazard ratio of 0.87 (95% CI, 0.83-0.90).

For the group of patients with initial diagnosis of stage IV advanced NSCLC, there was a 22% reduced risk at 1 year. The risk for all-cause mortality in this group of patients had a hazard ratio of 0.80 (95% CI, 0.77-0.84) after adjustment. The hazard ratio for 1-year risk for all-cause mortality after adjustment was 0.78 (95% CI, 0.75-0.82).

About half of the group who had biomarker testing were diagnosed between 2016 and 2019, compared with 29% in the group who did not receive testing. There were 84% and 56% of patients initially diagnosed at advanced stage of NSCLC in the adherent and non-adherent groups, respectively; 75% of patients in the adherent group who had stage IV disease at initial diagnosis versus 43% in the non-adherent group.

The overall patient population in this study had a mean age of 68 years at diagnosis. There was a smoking history in 84% of patients, and in 75% of those with initial advanced-stage diagnosis. Most of the patients received biomarker test results within 31 days after being diagnosed with advanced disease and a majority had their first line of treatment starting by 31 days after receiving their biomarker results. Patients from community practices made up 91% and 67% of patients had insurance plans.


1. John A, Yang B, Madala J, Shah RA. Clinical impact of adherence to NCCN biomarker testing guidelines on survival for patients with non-squamous, advanced non-small-cell lung cancer (aNSCLC). J Natl Compr Canc Netw. 2020;18(3.5):HSR20-088. doi:10.6004/jnccn.2019.7441

2. NCCN Clinical Practice Guidelines in Oncology. Non-small cell lung cancer, version 5.2020. Accessed June 12, 2020.