Summary
Molecular testing for biomarkers in patients with advanced/metastatic non-small cell lung cancer (a/mNSCLC) is essential for diagnosis and use of targeted therapy. Decades of research have demonstrated racial, regional, and socioeconomic differences in access to lung cancer procedures and diagnostic testing, which may be exacerbated in the era of precision medicine. We describe rebiopsy and retesting patterns of actionable genetic alterations across later lines of therapy (LOT) for patients with a/mNSCLC.
Methods
Retrospective real-world study utilizing the ConcertAI Patient360™ database to assess biomarker testing patterns and biopsy rates by LOT among adults with nonsquamous a/mNSCLC (2017–2022). Eligible patients received ≥1 LOT with ≥90-day follow-up. Analyses were stratified by race/ethnicity, region, age, and sex.
Results
Of 4528 patients, 51% were female, 76% were White, 76% were treated at community settings, and the mean (SD) age at index a/mNSCLC diagnosis was 67.2 (10.2) years. Among patients who received the corresponding LOT and any biomarker test for the prior line, those with EGFR wild-type (WT) status, Black patients, and male patients had lower crude rates of second-line (2L) rebiopsy (Table). At 2L, male patients had significantly lower rates of rebiopsy and retesting compared with female patients. Patients with EGFR WT status versus EGFR mutation had significantly lower rates of 2L rebiopsy, 2L retesting, and third-line (3L) rebiopsy. For patients with EGFR WT, the adjusted odds ratio (95% CI) for rebiopsy was significantly lower than patients with a known EGFR mutation at 2L (0.40 [0.28–0.59]; P<0.001) and 3L (0.46 [0.24–0.89]; P=0.020).
Conclusions
In this real-world study, racial and gender differences in rebiopsy and retesting were observed; patients with an actionable mutation were more likely to receive additional diagnostic procedures. Standardization of later LOT biomarker testing is needed for optimal and equitable treatment decisions for all patients with a/mNSCLC.
