Community Health Systems Test for Recommended Cancer Biomarkers More Often Than Independent Practices

In patients with advanced non-squamous non–small cell lung cancer treated within large community health systems in the United States (US), biomarker testing rates are similar to published reports from community health systems but appeared to be significantly higher compared with independent community practices, according to a presentation of retrospective findings given during the International Society for Pharmacoeconomics and Outcomes Research 2022.

The retrospective analysis also found that the majority of patients were test for biomarkers, but many did not receive all tests recommended by the National Comprehensive Cancer Network (NCCN). Moreover, there was a subset of patients who remained untested.

According to Alissa Winzeler, PhD of Synapse and co-investigators, 50% of cancer care is performed at community health systems, however, biomarker testing performed at these centers is not widely known. Investigators sought to provide more information with the retrospective analysis which utilized an electronic medical record (EMR)-derived database with data multiple cancer care settings.

Overall, data came from 33 US states, over 450 hospitals, and over 1,900 oncologists.

The records included in the analysis were from patients who were treated with antineoplastic treatment, and who had their biomarker testing or lack of biomarker testing confirmed by Synapse’s Certified Tumor Registrars. The data were both structured and unstructured.

All 2,091 patients were 18 years or older with advanced non-squamous NSCLC. Of the patient EMRs evaluated, 1,855 patients underwent biomarker testing for at least 1 of the recommended biomarkers. The 3 biomarkers commonly tested for in this study population were PD-L1 (81%), EGFR (77%), and ALK (71%). The 3 biomarkers that were not widely tested in the study population were NTRK1 (43%), NTRK2 (15%), and NTRK3 (43%).

Notably, 1,012 patients were tested for the 5 most common biomarkers, which include PD-L1, EGFR, ALK, BRAF, and ROS1.

A Decade of Biomarker Testing Patterns

The rate of documented biomarker testing is an area of active research that has been explored in small populations historically.

A retrospective observational of patients who received cancer care in a US Oncology Network center showed that between 2012 and 2016, EGFR testing rates were on the rise in stage IV NSCLC but still occurred in less than 50% of patients. For other common biomarkers like ALK, ROS1, PD-L1, and BRAF, rates of testing ranged from under 1% to 33%.²

Real-word data published in the Journal of Thoracic Oncology in May 2022 demonstrate an increase in the adoption of biomarker testing in the US between 2015 and 2021.³

Even with the rising numbers of oncologists ordering broad-based genomic testing in patients with nonsquamous NSCLC, nearly a third of patients still do not receive the necessary testing.

The study included record of 17,513 patients with advanced or metastatic nonsquamous NSCLC, of which 91.6% were treated at community-based practices. A total of 83,064 genomic biomarker test were reported during the 6-year period, but in 2015, only 28.3% received a biomarker test by next-generation sequencing. In 202, the proportion of patients who underwent biomarker testing climbed to 68.1%

Future Needs for Biomarker Testing

Findings from 2019 signaled the need for improvement of biomarker testing and education for advanced NSCLC in the real-world setting.² In 2022, evidence suggests that the implementation of NCCN-recommended biomarker testing practices in community oncology is on an upward trajectory.³

According to Winzeler et al, future research should focus on root causes of low biomarker testing rates at community health systems specifically and explore opportunities for progress.¹

_REFERENCES:

_{1. Winzeler A, Lorenzo R, Pomerantz D, et al. Biomarker testing rates among patients with advanced non-squamous non-small cell lung cancer treated within large community health systems in the US. Presented at: 2022 International Society for Pharmacoeconomics and Outcomes Research; May 15-18, 2022. Washington, DC. Abstract RWD33.}

_{2. Nadler E, Pacilack M, Clark J, et al. Biomarker testing rates in patients with advanced non-small cell lung cancer treated in the community. J Cancer Ther. 2019;10(12). doi: 10.4236/jct.2019.1012083}

_{3. Hess LM, Krein PM, Haldane D, et al. Biomarker Testing for Patients with Advanced/Metastatic Non-squamous Non-small Cell Lung Cancer (NSCLC) in the USA, 2015-2021. J Thorac Oncol. 2022. Published online May 7, 2022. doi: /10.1016/j.jtocrr.2022.100336}