Biomarker testing and time to treatment decision in patients with advanced nonsmall-cell lung cancer

Background: Testing for EGFR mutations and ALK rearrangement has become standard in managing advanced nonsmall- cell lung cancer ( NSCLC). However, many institutions in Europe, North America and other world regions continue to face a common challenge of facilitating timelymolecular testing with rapid result turnaround time. We assessed the prevalence of biomarker testing for advanced NSCLC patients and whether testing affected the timeliness of treatment decisions. Methods: We conducted a retrospective chart review of a random sample of one- quarter of all patients with advanced NSCLC referred to the PrincessMargaret Cancer Centre from 1 April 2010 to 31March 2013. Results: Of 300 patients reviewed, 175 seen by medical oncology had nonsquamous NSCLC, 72% of whom had biomarker testing carried out. Patients tested for biomarkers were more likely to be female ( 47% versus 21%, P = 0.002), Asian ( 27% versus 6%, P = 0.005) and never smokers ( 42% versus 8%, P < 0.0001). Only 21% of patients with biomarker testing had results available at their initial oncology consultation. This group had a shorter median time from consultation to treatment decision (0 versus 22 days, P = 0.0008) and time to treatment start (16 versus 29, P = 0.004). Thirteen percent underwent repeat biopsy for molecular testing after the initial consultation. Of those with positive EGFR or ALK results, 19% started chemotherapy before biomarker results became available. Conclusions: Awaiting biomarker testing results can delay treatment decisions and treatment initiation for patients with advanced NSCLC. This may be avoided by incorporating reflex biomarker testing into diagnostic algorithms for NSCLC at the level of the pathologist, and further education of specialists involved in obtaining diagnostic cancer specimens to ensure they are sufficient formolecular testing.