MYLUNG Study Finds Majority of Patients with Untreated Metastatic NSCLC Tested for at Least One Biomarker

Lung cancer is the leading cause of cancer death globally, with non–small-cell lung cancer (NSCLC) accounting for 80% to 85% of all lung cancer cases.¹ Although pathologically patients may have the same type of NSCLC, patients may experience different responses to treatment due to different cancer genetics.¹ Molecular testing has been incorporated into NSCLC diagnostic standards, and treatment based on these test results is an important part of patient management.² EGFR, BRAF, and MET mutations; ALK, ROS1, RET, and NTRK translocations; and PD-L1 protein expression are all analyzed to direct targeted therapy.² This approach to individualized precision treatment has led to an improvement in the survival time of patients with advanced NSCLC.¹

The Molecularly Informed Lung Cancer Treatment in a Community Cancer Network (MYLUNG) consortium conducted a 2-year retrospective observational chart review study of 3474 adult patients with untreated metastatic NSCLC from 2018 to 2020. Testing rates for ALK, BRAF, EGFR, ROS1, and PD-L1 were assessed along with the use of full next-generation sequencing (NGS) panels. The timing of biomarker testing was used to sort patients into 3 cohorts. Cohort 1 had testing prior to first-line therapy, cohort 2 had testing after first-line therapy, and cohort 3 received no biomarker testing. The median time from metastatic NSCLC diagnosis to receiving biomarker results ranged from 14 to 21 days, with a median turnaround time for testing of 10 to 15 days for the individual biomarkers. The median time from diagnosis to first-line therapy was 5 weeks.

The median age of patients was 69 years with a wide range of 23 to 90 years. Patient population was almost evenly split between males and females, with 51% of the patients being female. A majority (74%) had adenocarcinoma and 76% had Eastern Cooperative Oncology Group performance status of 0 or 1. A least 1 biomarker test was performed in 90% of the patients. All 5 biomarker tests were performed for 46% of the patients. Examination of changes in testing rates during the study period found that testing for all 5 biomarkers increased from 42% to 49%, for BRAF testing it increased from 51% to 59%, and testing rates increased from 82% to 84% for PD-L1. There was also an increase in NGS testing from 33% to 44%. EGFR testing rates remained static at 71%. There were slight decreases in testing rates for ALK (from 71% to 70%) and for ROS1 (from 69% to 67%).

Although most patients received ≥1 biomarker tests before therapy was initiated, <50% of patients received all 5 biomarker tests or NGS testing. The next MYLUNG study will further examine real-world trends in NSCLC biomarker testing.

Source

Robert N, Nwokeji E, Espirito J, et al. Biomarker tissue journey among patients (pts) with untreated metastatic non-small cell lung cancer (mNSCLC) in the U.S. Oncology Network community practices. J Clin Oncol. 2021;39(suppl_5):s9004.

References

1. Dong J, Li B, Lin D, et al. Advances in targeted therapy and immunotherapy for non-small cell lung cancer based on accurate molecular typing. Front Pharmacol. 2019;10:230.
2. Imyanitov EN, Iyevleva AG, Levchenko EV. Molecular testing and targeted therapy for non-small cell lung cancer: current status and perspectives. Crit Rev Oncol Hematol. 2021;157:103194.