Molecular Testing Appears To Be Increasing in eNSCLC

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An increasing number of patients with eNSCLC currently have access to biomarker testing and targeted therapies, according to the MYLUNG consortium.

Biomarker testing and targeted therapies appear to be increasingly available to patients with early-stage non-small-cell lung cancer (eNSCLC), according to updated results of ongoing industry-sponsored research from the Molecularly Informed Lung Cancer Treatment in a Community Cancer Network: A Pragmatic Consortium (MYLUNG) consortium.

“New therapeutic options provide a catalyst to increase molecular testing in eNSCLC, and prescription of appropriate targeted therapies improves outcomes for patients with NSCLC. Molecular testing for PD-L1 and EGFR is now standard in eNSCLC. With the recent approval of ALK-targeted therapy in the adjuvant setting, testing for this biomarker is expected to increase,” Makenzi Colleen Evangelist, MD, MS, and coauthors wrote in their poster presented at the 2024 ASCO Annual Meeting and in the Journal of Clinical Oncology.

“The importance of molecular testing in this population is underscored by positive predictors of response (PD-L1, EGFR, and ALK) to approved treatments as well as negative predictors of response (EGFR and ALK) to adjuvant immunotherapy,” they add.

In their series of studies, Dr. Evangelist and her colleagues in the MYLUNG program aimed to identify and resolve barriers to biomarker testing in patients with NSCLC.

“We previously reported early findings from prospectively collected molecular testing data in patients with Stage IB-IV NSCLC,” they wrote. “Here, we report additional data on molecular testing rates and patterns in the cohort of patients with eNSCLC, defined as Stage IB-IIIA NSCLC.”

Dr. Evangelist and her colleagues conducted the prospective observational study in 284 patients with newly diagnosed Stage IB-IIIA NSCLC of any histology at 76 sites in 18 community practices from December 2020 to September 2022. The median participant age was 68 years, 50% were female, 54% had Eastern Cooperative Oncology Group (ECOG) scores of 0 (fully active and performing as well as prior to disease onset) or 1 (limited to walking and carrying out light, sedentary work such as light housework and office work). Among these, 61% of participants had adenocarcinoma, and 36% had squamous cell carcinoma (Figure).

The researchers found that:

• Overall, 76% of patients with eNSCLC seen in community practices (82% of patients with adenocarcinoma and 67% with squamous cell carcinoma) received molecular testing for at least one biomarker prior to or within 12 weeks of their first systemic therapy. Half of all patients received next-generation sequencing, and 60% of patients with Stage IB-IIIA NSCLC received PD-L1 + EGFR
• Immunotherapy was prescribed as the first systemic therapy in 52% of patients; of those patients, 43% had a negative PD-L1 test or no PD-L1 test.
• As a result of adjuvant biomarker testing, more than 50% of patients with an EGFR mutation received an EGFR inhibitor in their first systemic therapy within 20 months of FDA approval of adjuvant osimertinib.
• The reasons for not performing molecular testing included patient or provider attitudes or perceptions in 34% of cases and insufficient tumor tissue in 25%.

“Analyses reported here are preliminary as data continue to be collected over 5-year follow-up,” the authors wrote in their poster. “Interventions designed to address the barriers to and perceptions of molecular testing identified in this study are currently being developed or are underway as part of the next phase of the MYLUNG program…We anticipate increased testing for ALK alterations in the adjuvant setting and will continue to measure ALK testing in the ongoing MYLUNG study.”