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Patterns of Biomarker Testing in Metastatic NSCLC in the Community Oncology Setting

2021 Year in Review - Non–Small-Cell Lung Cancer

Lung and bronchus cancer was the second most frequent cancer form in 2017, accounting for 13% of all new cancer cases in the United States.1 Non–small-cell lung cancer (NSCLC) accounted for approximately 80% to 85% of the estimated 222,550 lung and bronchus cancer cases reported in 2017.1 The majority of people with NSCLC are diagnosed when it has progressed to the stage of metastatic disease.1

In metastatic NSCLC, national recommendations advocate biomarker testing, and targeted therapy is linked to better results.2 There is evidence that predictive biomarker testing and subsequent first-line targeted therapy treatment in patients with NSCLC has not been widely adopted in the clinical context, despite clear therapeutic benefit and guideline recommendations.1

The US Oncology Network structured electronic health records data were used to conduct a retrospective analysis of adult patients diagnosed with de novo metastatic NSCLC between January 1, 2016, and September 30, 2019, with follow-up through December 31, 2019.2 Patients with metastatic NSCLC who underwent systemic treatment were included in the study.2

Overall, 23.6% of participants were never tested for a biomarker (PD-L1 or driver mutation) during the study, and only 49% got a biomarker test result prior to receiving first-line therapy.2 When assessing driver mutation specifically, similar patterns were found: 35.8% had never been tested for driver mutation, and only 39.3% had a driver mutation test result prior to first-line therapy.2

Despite the availability of promising biomarker-based treatments, insufficient testing in the community oncology context implies that not all eligible patients receive the most effective therapies right away.2 In this metastatic NSCLC cohort (all histologies), >61% had no driver mutation test reported before first-line treatment, and some were later found to be driver mutation–positive, emphasizing a wasted chance to use the most effective biomarker-directed frontline treatment.2

Providers have considerable hurdles due to rapidly changing recommendations and growing understanding of many actionable biomarkers in cancer care.1 Advances in NSCLC diagnosis and treatment are important to increasing survival rates.1 Compared with traditional cytotoxic chemotherapies, the recent identification of some of the driver mutations for NSCLC has enabled more choices for personalized targeted treatment.1 As a result, routine molecular testing for the detection of specific known genetic anomalies is now a standard guideline for patients with advanced NSCLC.1


  1. Mason C, Ellis PG, Lokay K, et al. Patterns of biomarker testing rates and appropriate use of targeted therapy in the first-line, metastatic non-small cell lung cancer treatment setting. J Clin Pathw. 2018;4:49-54.
  2. Nadler ES, Vasudevan A, Davies K, et al. Real-world patterns of biomarker testing and targeted therapy in metastatic non-small cell lung cancer (mNSCLC) in the community oncology setting. J Clin Oncol. 2021;39(suppl 15):Abstract 9079.

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