‘Real-World’ Increase in Biomarker Testing in NSCLC

At last, the number of patients diagnosed with advanced non–small cell lung cancer (NSCLC) who undergo biomarker testing is increasing, at least this is the conclusion from a study of real-world data from Spain.

For years now, there has been concern at the low rates of biomarker testing in such patients. By not testing, these patients are deprived of a chance to try targeted therapy, which may improve survival. “Oncologists [are] still failing ‘woefully’ at molecular testing in lung cancer,” wrote H. Jack West, MD, from the City of Hope Comprehensive Cancer Care, in a Medscape commentary in September 2021.

The new study from Spain shows that progress is being made.

Optimally, patients with advanced NSCLC should be evaluated for at least five biomarkers: ALK, BRAF, EGFR, ROS1, and PD-L1. Targeted therapies against all of these are now available, explained the lead author, Virginia Calvo de Juan, MD, Hospital Universitario Puerta de Hierro-Majadahond, Madrid, Spain.

The team assessed biomarker testing as documented in the Thoracic Tumours Registry, an observational, prospective registry in Spain that included 9239 patients with stage IV NSCLC who were diagnosed between 2016 and now. The registry includes data from 182 hospitals across Spain.

“Results showed that tumour biomarker testing was performed in 85% of patients with nonsquamous tumours and 56.3% of those with squamous tumors and that’s important for making treatment decisions,” Calvo de Juan said.

Importantly as well, over 44% of patients who underwent biomarker testing tested positive for ALK, BRAF, EGFR , KRAS, BRAF, ROS1, or PD-L1, she added.

Analysis of the registry also showed that there has been a significant increase in all molecular testing over the past few years. “The key message here is that it is very important to have a registry to collect information on real-life cancer care,” she noted.

“We can’t do better if we don’t have a clear idea of what we are doing in routine clinical practice,” she added.

The new data were presented at the European Lung Cancer Congress (ELCC), which was held virtually this year.

In an ELCC conference press release, Rolf Stahel, MD, president of the European Thoracic Oncology Platform, commented that this Spanish group is one of the best study groups in Europe and is very committed to providing targeted treatments to lung cancer patients.

“Analyzing the registry data shows a very high rate of molecular testing over a 5-year period,” Stahel reaffirmed.

“Cancer registries are very important in improving outcomes for cancer patients for several reasons,” Stahel continued. Registries that include hospital-based or even population-based data can be analyzed for various aspects of cancer diagnosis, treatment, and outcomes. “You can then look at how a particular hospital or region is performing, benchmark [that] against other populations, and see where you stand and how you can improve,” Stahel said.

“The overall survival of patients with lung cancer has increased by around 15% over the last decade, primarily because we now have new therapies, including targeted drugs [to treat these patients],” Calvo de Juan commented.

“But in order to use these therapies, we need to determine the molecular biomarkers on a patient’s tumors,” she added.

European Lung Cancer Congress (ELCC): Abstract 39P. Presented March 23, 2022.

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