Differences in biomarker testing in non-small cell lung cancer: real-world outcomes within an integrated healthcare system

TL;DR

This study shows that biomarker testing for lung cancer is more common in advanced stages and is linked to better survival, especially when using next-generation sequencing.

Contribution

The study provides real-world evidence on biomarker testing patterns and outcomes in a diverse NSCLC population.

Findings

Biomarker testing prevalence increased with cancer stage, from 6.9% in stage I to 71.1% in stage IV.

NGS testing was associated with a 13% decrease in 3-year all-cause mortality compared to no testing.

Younger age, never smoking, Asian race, and stage IV disease were independent predictors of biomarker testing.

Abstract

While biomarker testing can guide lung cancer treatment, its real-world application in community practice remains underexplored. This study examines the prevalence, predictors, and outcomes of biomarker testing in non-small cell lung cancer (NSCLC).

This retrospective cohort study included adults diagnosed with primary NSCLC from 2013 to 2020 within a large integrated healthcare system. We linked cancer registry and electronic health records to determine the prevalence of biomarker testing, including single-gene, multi-gene, and next-generation sequencing (NGS), overall and stratified by patient characteristics including age, gender, race/ethnicity, smoking status, and stage. Multivariable regression analyses were conducted to identify independent predictors of biomarker testing and evaluate associations between type of biomarker testing and 3-year all-cause mortality, overall and stratified by stage.

Among 8,267 NSCLC patients, 38.9% received biomarker testing. Testing prevalence increased with disease stage: I (6.9%), II (18.0%), III (34.8%), IV (71.1%). Testing was more prevalent in patients aged <65 years, of Asian race, and who never smoked, lived in less deprived neighborhoods, and had non-squamous tumors. Younger age, never smoking, Asian race, and stage IV disease were independent predictors of biomarker testing. NGS vs. no testing was associated with 13% decreases in 3-year all-cause mortality.

Biomarker testing prevalence was higher in advanced stage NSCLC as expected, with decreased 3-year mortality in patients who received NGS testing. Our findings in a large real-world diverse population suggest that broader uptake of comprehensive biomarker testing across all stages of NSCLC is warranted for improved outcomes.

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