Biomarker testing and time to treatment decision in patients with advanced nonsmall-cell lung cancer.
BACKGROUND
Testing for EGFR mutations and ALK rearrangement has become standard in managing advanced nonsmall-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 1 April 2010 to 31 March 2013.


RESULTS
Of 300 patients reviewed, 175 seen by medical oncology had nonsquamous NSCLC, 72% of whom had biomarker testing carried out. Patients tested for biomarkers were more likely to be female (47% versus 21%, P = 0.002), Asian (27% versus 6%, P = 0.005) and never smokers (42% versus 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 versus 22 days, P = 0.0008) and time to treatment start (16 versus 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.
Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto.
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C
Lim
Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto.
M S
MS
Tsao
Department of Biostatistics, Princess Margaret Cancer Centre, Toronto.
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LW
Le
Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto.
F A
FA
Shepherd
Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto.
R
R
Feld
Division of Medical Oncology, Mount Sinai Hospital, Toronto.
R L
RL
Burkes
Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto.
G
G
Liu
Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto Molecular Diagnostics Laboratory, University Health Network, Toronto, Canada.
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S
Kamel-Reid
Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto.
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D
Hwang
Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto.
J
J
Tanguay
Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto.
G
G
da Cunha Santos
Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto natasha.leighl@uhn.ca.
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Leighl
D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000235:genetics*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D003657:Decision Making; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D061665:Time-to-Treatment; D055815:Young Adult
D014408:Biomarkers, Tumor; C512478:EGFR protein, human; D066246:ErbB Receptors
ALK; EGFR; NSCLC; biomarkers; molecular testing; quality of care