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Contemporary management of advanced non-small cell lung cancer (aNSCLC) in a large, real-world cohort

Published

June 2016

Citation

Presley, CJ, Harrington, E, Gippetti, J, Agarwala, V, Bowser, B, Adelson, KB, Herbst, RS, Abernethy, AP, Gross, CP. . ASCO Annual Meeting. .

https://meetinglibrary.asco.org/record/126995/abstract

Authors:
Presley, CJ, Harrington, E, Gippetti, J, Agarwala, V, Bowser, B, Adelson, KB, Herbst, RS, Abernethy, AP, Gross, CP

Background:In the era of precision medicine for NSCLC, the use of tumor genotyping and novel therapies in routine clinical practice is unknown.Methods:Patient characteristics, genotype testing, and treatment patterns were evaluated using the Flatiron Health database of patient-level data abstracted from electronic health records at > 150 (largely community) oncology practices across the U.S. We identified a representative random cohort of aNSCLC patients who received care during 2011 through 2015. We used chi-square analyses to identify characteristics associated with genotype testing.Results:Among the 17,696 patients identified, 54.5% (9,639) of patients had recommended genotype testing (EGFR or ALK) documented in their chart and 43.5% (7,692) had no documented testing. We also identified a cohort of 365 patients who received documented NGS tumor profiling as part of routine care. Younger age at diagnosis, white race, non-smoker, commercial insurance, and non-squamous histology were all significantly associated with documented NGS testing (p<0.001). Among NGS-tested patients, the most commonly altered genes were TP53 (62%), KRAS (30%), EGFR (18%), STK11 (15%), and CDKN2A/B (14%). Between 2012 and 2015, chemotherapy use decreased (90.7% to 82.8%), while targeted therapy and immunotherapy use grew substantially (16.6% to 19.7%, and 0.3% to 16.5%, respectively).Conclusions:The management of aNSCLC in community practice is rapidly evolving due to targeted therapy and immunotherapy, but disparities in access to biomarker testing persist.

Sources:
ASCO Annual Meeting

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