title: Molecular testing patterns in metastatic non-small cell lung cancer.
abstract: OBJECTIVE
  Identification of oncogene mutations and gene rearrangements in individuals with non-small cell lung cancer (NSCLC) can help identify candidates for targeted therapy. This study examined whether clinicians are ordering molecular testing for patients with metastatic NSCLC (mNSCLC) prior to therapy initiation.
  
  
  METHODS
  Members from a national health plan with lung cancer and metastatic disease were followed retrospectively.
  
  
  METHODS
  Members were identified in medical claims data from January 1, 2010, to December 31, 2012, if they had 2 or more claims for lung cancer (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 162.xx) and metastatic disease (≥ 1 claim with ICD-9-CM code 196.xx-198.xx) who were continuously enrolled in a fully insured plan 180 days prior to index date. Patients were excluded if they had a history of chemotherapy used primarily in small cell lung cancer, or a medical claim associated with an unrelated malignancy. The timing of molecular testing was compared with the start of chemotherapy and targeted therapy, if applicable.
  
  
  RESULTS
  A total of 2623 patients presumed to have mNSCLC were included for analysis; of whom, 52.5% were male with a mean age of 72.5 years (SD = 8.2 years). A total of 1597 (60.9%) patients had a Current Procedural Terminology code associated with molecular testing at any time in their claims history. Of the 733 patients with molecular testing and chemotherapy or targeted therapy claims, testing occurred prior to systemic therapy initiation in 651 (88.8%; 95% CI, 86.1%-90.9%) patients. The median time between testing and therapy initiation was 38 days (interquartile range = 23-69 days).
  
  
  CONCLUSIONS
  Assessment of oncogene mutations and gene rearrangements in mNSCLC routinely occurs prior to treatment initiation as suggested by analyses of claims data from a large US health plan. Validation using patient medical records is needed.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: MacLean
authors.forename: Anthony
authors.initials: A
authors.lastname: Louder
authors.forename: Kim
authors.initials: K
authors.lastname: Saverno
authors.forename: Gregory
authors.initials: G
authors.lastname: Smith
authors.forename: Jack
authors.initials: J
authors.lastname: Mardekian
authors.forename: Cari
authors.initials: C
authors.lastname: Brunis
authors.forename: Mela
authors.initials: M
authors.lastname: Ward
authors.forename: Robert
authors.initials: R
authors.lastname: Sweetman
authors.affiliation: Comprehensive Health Insights, Inc, 515 W Market St, Louisville, KY 40202. E-mail: mpasquale@humana.com.
authors.forename: Margaret
authors.initials: M
authors.lastname: Pasquale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008175:Lung Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000706:statistics & numerical data*; D009154:Mutation / Q000235:genetics; D009362:Neoplasm Metastasis; D009857:Oncogenes / Q000235:genetics; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult