Biomarker Testing and Time to Treatment Decision in Patients with Advanced Non-Small Cell Lung Cancer
Menée sur 300 patients atteints d'un cancer du poumon non à petites cellules de stade avancé et traités dans un centre canadien entre avril 2010 et mars 2013, cette étude rétrospective évalue le nombre de patients ayant bénéficié de tests de recherche de mutations EGFR et de réarrangements ALK et, parmi eux, la proportion de patients dont les résultats des tests ont influencé le choix thérapeutique
Background : Testing for EGFR mutations and ALK rearrangement has become standard in managing advanced non-small cell lung cancer (NSCLC). However, many institutions in Europe, North America, and other world regions continue to face a common challenge of facilitating timely molecular testing with rapid result turnaround time. We assessed the prevalence of biomarker testing for advanced NSCLC patients and whether testing affected the timeliness of treatment decisions.
Methods : We conducted a retrospective chart review of a random sample of one quarter of all patients with advanced NSCLC referred to the Princess Margaret Cancer Centre from April 1, 2010 to March 31, 2013.
Results : Of 300 patients reviewed, 175 seen by medical oncology had non-squamous NSCLC, 72% of whom had biomarker testing performed. Patients tested for biomarkers were more likely to be female (47% vs. 21%, p=0.002), Asian (27% vs. 6%, p=0.005) and never-smokers (42% vs. 8%, p<0.0001). Only 21% of patients with biomarker testing had results available at their initial oncology consultation. This group had a shorter median time from consultation to treatment decision (0 vs. 22 days, p=0.0008) and time to treatment start (16 vs. 29, p=0.004). Thirteen percent underwent repeat biopsy for molecular testing after the initial consultation. Of those with positive EGFR or ALK results, 19% started chemotherapy before biomarker results became available.
Conclusions : Awaiting biomarker testing results can delay treatment decisions and treatment initiation for patients with advanced NSCLC. This may be avoided by incorporating reflex biomarker testing into diagnostic algorithms for NSCLC at the level of the pathologist, and further education of specialists involved in obtaining diagnostic cancer specimens to ensure they are sufficient for molecular testing.
Annals of Oncology , résumé, 2015