title: Impact of Reflex EGFR/ ALK Testing on Time to Treatment of Patients With Advanced Nonsquamous Non-Small-Cell Lung Cancer.
abstract: Optimal first-line systemic therapy for patients with advanced nonsquamous (nonsq) non-small-cell lung cancer (NSCLC) requires confirmation of EGFR/ ALK status, which can delay treatment. We evaluated the impact of reflex testing, defined as pathologists initiating EGFR/ ALK testing at the time of diagnosis of nonsq NSCLC, on time to treatment (TTT).
  
  
  
  We conducted a retrospective review of patients with nonsq NSCLC with medical oncology consultation at Sunnybrook Odette Cancer Centre between March 18, 2010 and April 30, 2014. Data were compared during routine and reflex testing. TTT was defined as the interval between the first medical oncology visit with advanced NSCLC and the initiation of systemic therapy.
  
  
  
  A total of 306 patients were included (n = 232 for routine testing, n = 74 for reflex testing). There was a trend to improvement in median TTT with reflex testing (36 days [interquartile range {IQR}, 16 to 71 days v 26 days [IQR, 8 to 41 days], P = .071). Omitting patients with intentional delays in systemic therapy for low-volume disease, poor performance status, comorbidity management, and/or radiation therapy, median TTT improved (34 days [IQR, 15 to 67 days] v 22 days [IQR, 8 to 42 days], P = .049). Time to optimal first-line systemic therapy according to published guidelines improved (median, 36 days [IQR, 16 to 91 days] v 24 days [IQR, 8 to 43 days], P = .036). There was no impact on receipt of any first-line systemic therapy (55% v 59%, P = .66). The quality of biomarker testing improved, with fewer unsuccessful tests ( EGFR, 14% v 4%, P = .039; and ALK, 17% v 3%, P = .037).
  
  
  
  Reflex testing of EGFR/ ALK improved the time to optimal systemic therapy and the quality of biomarker testing for patients with advanced nonsq NSCLC.
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Parneet K
authors.initials: PK
authors.lastname: Cheema
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Ines B
authors.initials: IB
authors.lastname: Menjak
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Winterton-Perks
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Raphael
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Susanna Y
authors.initials: SY
authors.lastname: Cheng
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Sunil
authors.initials: S
authors.lastname: Verma
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Muinuddin
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Freedman
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Nevkeet
authors.initials: N
authors.lastname: Toor
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Perera
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Anaka
authors.affiliation: Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
mesh_terms: D000368:Aged; D000077548:Anaplastic Lymphoma Kinase; D014408:Biomarkers, Tumor / Q000235:genetics; D002289:Carcinoma, Non-Small-Cell Lung / Q000235:genetics* / Q000628:therapy; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D057285:Precision Medicine / Q000379:methods; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics*; D012189:Retrospective Studies; D061665:Time-to-Treatment
chemical_list: D014408:Biomarkers, Tumor; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; C512478:EGFR protein, human; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases