Real-World Molecular Testing Rates and Patterns in Patients With Primary Advanced or Recurrent Endometrial Cancer in the United States.

PURPOSE

This retrospective cohort study estimated the real-world utilization of biomarker testing among patients with primary advanced/recurrent endometrial cancer (pA/rEC) and characterized testing according to demographic and clinical characteristics.

MATERIALS AND METHODS

A nationwide electronic health record-derived deidentified database was used. Records from January 1, 2013, to August 31, 2023, for women age 18 years and older with pA/rEC were searched for DNA mismatch repair (MMR)/microsatellite instability (MSI), human epidermal growth factor receptor 2 (HER2), and estrogen receptor (ER) or progesterone receptor (PR) testing; a subsample data set (advEndo Spotlight) was searched from April 1, 2013, to November 30, 2022, for additional biomolecular testing. Testing rates were reported by index year and molecular marker. Multivariate logistic regression analyses were conducted to identify characteristics associated with testing.

RESULTS

The full data set included 2,982 patients, of whom 53% were age 65 years and older; most were non-Hispanic White (56%) and received care in a community setting (73%). The advEndo Spotlight subsample (n = 509) had similar characteristics. From 2013 to 2021, testing for any biomarker increased from 53% to 89% (MMR/MSI, 17% to 81%; ER/PR, 45% to 62%; HER2, 15% to 43%). Patients who received care at an academic versus community facility, had commercial/other insurance versus Medicare/Medicaid, had primary advanced versus recurrent EC, had endometrioid versus nonendometrioid carcinoma, or had no previous surgery as part of primary treatment were more likely to receive testing.

CONCLUSION

Molecular testing rates in pA/rEC have increased over time, likely due in part to incorporation of biomarker testing into treatment guidelines. This highlights an unmet need to ensure universal access to testing in patients with pA/rEC. Understanding these factors can inform approaches to increase access to molecular testing and increase testing rates.