Nadler Eric, Vasudevan Anupama, Wang Yunfei, Ogale Sarika
The US Oncology Network, 10101 Woodloch Forest Dr, The Woodlands, TX 77380, United States.
Ontada, 6555 State Highway 161, Irving, TX 75039, United States.
Cancer Treat Res Commun. 2022;31:100522. doi: 10.1016/j.ctarc.2022.100522. Epub 2022 Jan 29.
This study investigated biomarker testing and biomarker-guided treatment among patients with metastatic NSCLC in a real-world setting.
This retrospective study examined adult patients diagnosed with de novo mNSCLC between 01-Jan-2016 and 30-Sep-2019, with follow-up through 31-Dec-2019 using The US Oncology Network structured electronic health records data, with chart review for a subset.
Of 2257 patients, 76.3% had results for ≥1 driver mutation (DM) or programmed death ligand-1 (PD-L1) during the study observation period. The proportion with results for all 4 DM before 1L initiation increased from 2017 to 2019. Over 40% had results for anaplastic lymphoma kinase (ALK), epidermal growth factor receptor (EGFR), and c-ros oncogene 1 (ROS1) and 22% for B-Raf proto-oncogene (BRAF) before 1L initiation by structured data. In the chart review subset (n = 197), >70% had results for ALK, EGFR, or ROS1 with 44% for BRAF. Of the 42 ALK+ patients, 5 had results before 1L treatment and 3 received 1L ALK inhibitors. Similar, for the other biomarkers, not all who tested positive for a DM received 1L targeted therapy. The proportion of biomarker-positive patients receiving 1L targeted therapy was higher in chart review versus structured data. However, in both analyses, a substantial proportion did not have results for all 4 DM plus PD-L1 tests for appropriate biomarker-directed 1L treatment selection.
Despite increasing biomarker testing rates, reduced turnaround times, and availability of promising biomarker-based therapies, inadequate testing in the community oncology setting means that not all eligible patients are receiving the most effective therapies up front.
本研究在真实世界环境中调查了转移性非小细胞肺癌（NSCLC）患者的生物标志物检测及生物标志物指导的治疗情况。
这项回顾性研究纳入了2016年1月1日至2019年9月30日期间诊断为初治转移性NSCLC的成年患者，使用美国肿瘤网络结构化电子健康记录数据进行随访至2019年12月31日，并对一部分患者进行了病历审查。
在2257例患者中，76.3%在研究观察期内有≥1种驱动基因突变（DM）或程序性死亡配体-1（PD-L1）检测结果。2017年至2019年期间，一线治疗开始前所有4种DM检测结果的比例有所增加。超过40%的患者在一线治疗开始前通过结构化数据检测到间变性淋巴瘤激酶（ALK）、表皮生长因子受体（EGFR）和c-ros癌基因1（ROS1），22%检测到B-Raf原癌基因（BRAF）。在病历审查子集中（n = 197），>70%的患者检测到ALK、EGFR或ROS1，44%检测到BRAF。在42例ALK阳性患者中，5例在一线治疗前有检测结果，3例接受了一线ALK抑制剂治疗。同样，对于其他生物标志物，并非所有DM检测呈阳性的患者都接受了一线靶向治疗。病历审查中生物标志物阳性患者接受一线靶向治疗的比例高于结构化数据。然而，在两项分析中，很大一部分患者没有进行所有4种DM加PD-L1检测的结果，无法进行适当的生物标志物指导的一线治疗选择。
尽管生物标志物检测率不断提高、周转时间缩短且有前景的基于生物标志物的疗法可用，但社区肿瘤环境中的检测不足意味着并非所有符合条件的患者都能预先接受最有效的治疗。
