Summary
Molecular testing for biomarkers in patients (pts) with advanced/metastatic NSCLC (a/mNSCLC) is essential for diagnostic testing and use of targeted therapy. Testing patterns across lines of therapy (LOT) for pts with a/mNSCLC remain unclear.
Methods
This retrospective real-world study used ConcertAI Patient360™ database to assess biomarker testing patterns among adults with nonsquamous a/mNSCLC (2017–2022). Eligible pts received ≥1 LOT with ≥90-day follow-up. Biopsy and biomarker testing assessed actionable genetic alterations (ALK, BRAF, EGFR, KRAS, NTRK, RET, ROS1) and PD-L1 by LOT (first-, second-, third-line [1L, 2L, 3L]), test modality (IHC, FISH, CISH, NGS, PCR), and sample type (tissue/liquid).
Results
4528 pts were included; median age 67 years and from a community setting (76%). NGS rate at 1L was 57% overall (2017–2022) and increased to 80% during 2020–2022. Testing for ≥1 biomarker was 85% (1L), 31% (2L), 26% (3L) (overall, 2017–2022); and 89% (1L), 37% (2L), 28% (3L) (2020–2022). EGFR, BRAF, KRAS, RET, and ROS1 (Table) were mostly tested using NGS (56% at 1L vs 51% IHC, 21% FISH, and 10% PCR). Testing was most often conducted with tissue at 1L (64%) and liquid in 2L+ (41% each of tested 2L pts and 3L pts). At 2L, only 6% of pts had tissue re-biopsy, which dropped to 4% in 3L. Pts with 1L targeted therapy had higher re-testing (41% vs 25%, P<0.001) rates regardless of sample type in 2L than those who did not.
Conclusions
Tissue was most frequently used in 1L for biomarker testing by NGS for genetic alterations or IHC for PD-L1; however, tissue was not regularly re-biopsied in 2L+ settings. Biomarker testing rates drop as pts navigate through LOT. Re-testing rate is higher among pts with an actionable mutation in 1L. Standardization of biomarker testing post-1L is needed to facilitate optimal later-line treatment decisions and individualized care for pts with a/mNSCLC.
