TARGETED THERAPY, IMMUNOTHERAPY, AND MOLECULAR TESTING IN ADVANCED SOLID TUMORS: A 2021-2025 MEDICARE ANALYSIS
Author(s)
Onur Baser, MA, MS, PhD1, Nehir Yapar, BS2, Katarzyna Rodchenko, MA, MPH2, Shuangrui Chen, MS2, Lixuan Wu, MS2;
1City University of New York (CUNY), Graduate School of Public Health, New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA
1City University of New York (CUNY), Graduate School of Public Health, New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA
OBJECTIVES: Describe biomarker testing patterns, targeted and immunotherapy use, and short‑term outcomes among Medicare beneficiaries with advanced lung, breast, gastrointestinal (GI)/genitourinary (GU) cancers.
METHODS: Medicare-Enhanced Lab & Demographics (MELDTM) data with deterministically-linked 100% Medicare fee‑for‑service (FFS) claims+ EMR and patient‑reported outcome (PRO) measures was used to create a retrospective cohort of FFS beneficiaries aged ≥65 years with incident advanced/metastatic non-small-cell lung cancer (NSCLC), breast, colorectal (CRC), gastric, or urothelial cancer, 2021-2025. Next‑generation sequencing (NGS) and biomarker testing (EGFR/ALK/ROS1/BRAF/KRAS, HER2, PD‑L1, MSI/MMR) ascertained from EMR and laboratory feeds; systemic therapies from claims. Outcomes: Proportion received broad NGS/guideline‑concordant biomarker testing pre-1L therapy; Proportion received 1L biomarker‑matched targeted/immuno-oncology (IO) regimens; 12‑month overall survival (OS; testing, treatment status). Weighted models adjusted for age, comorbidity, tumor type, stage.
RESULTS: Among 152,000 eligible beneficiaries (median age=74; female:54%); tumor distribution: NSCLC:32%, breast:38%, colorectal/gastric:20%, urothelial:10%. Overall, 48% underwent any biomarker testing pre-1L therapy; broad NGS: 29%, with higher rates in NSCLC (≈60% any testing) and CRC; lower in breast, urothelial cancers. Among tested, patients (NSCLC:26%, breast:18%, GI/GU:14%) had actionable alteration for 1L therapy, aligning with prior series. Across tumors, 34% received 1L biomarker‑matched targeted agent or IO combination, rising to 62% among those with actionable results. Comprehensive NGS and biomarker‑matched 1L therapy showed higher adjusted 12‑month OS than without testing or matched treatment (NSCLC 12‑month OS≈62% vs 45%; CRC≈50% vs 38%). NGS: Diagnosis to 1L therapy was longer (median:32 vs 27 days), without OS penalty. PROs showed improved physical function at 6 months with treatment with matched targeted/IO regimens vs empiric chemotherapy.
CONCLUSIONS: Linked Medicare claims+EMR analysis enabled real-world integrated assessment of biomarker testing and targeted/IO uptake for advanced solid tumors. Nearly one-half: Biomarker testing; roughly one‑third: Biomarker‑matched 1L therapy, which was associated with improved 12‑month survival, supporting the benefit of broad NGS‑guided, targeted, and immunotherapy‑based strategies in routine practice.
METHODS: Medicare-Enhanced Lab & Demographics (MELDTM) data with deterministically-linked 100% Medicare fee‑for‑service (FFS) claims+ EMR and patient‑reported outcome (PRO) measures was used to create a retrospective cohort of FFS beneficiaries aged ≥65 years with incident advanced/metastatic non-small-cell lung cancer (NSCLC), breast, colorectal (CRC), gastric, or urothelial cancer, 2021-2025. Next‑generation sequencing (NGS) and biomarker testing (EGFR/ALK/ROS1/BRAF/KRAS, HER2, PD‑L1, MSI/MMR) ascertained from EMR and laboratory feeds; systemic therapies from claims. Outcomes: Proportion received broad NGS/guideline‑concordant biomarker testing pre-1L therapy; Proportion received 1L biomarker‑matched targeted/immuno-oncology (IO) regimens; 12‑month overall survival (OS; testing, treatment status). Weighted models adjusted for age, comorbidity, tumor type, stage.
RESULTS: Among 152,000 eligible beneficiaries (median age=74; female:54%); tumor distribution: NSCLC:32%, breast:38%, colorectal/gastric:20%, urothelial:10%. Overall, 48% underwent any biomarker testing pre-1L therapy; broad NGS: 29%, with higher rates in NSCLC (≈60% any testing) and CRC; lower in breast, urothelial cancers. Among tested, patients (NSCLC:26%, breast:18%, GI/GU:14%) had actionable alteration for 1L therapy, aligning with prior series. Across tumors, 34% received 1L biomarker‑matched targeted agent or IO combination, rising to 62% among those with actionable results. Comprehensive NGS and biomarker‑matched 1L therapy showed higher adjusted 12‑month OS than without testing or matched treatment (NSCLC 12‑month OS≈62% vs 45%; CRC≈50% vs 38%). NGS: Diagnosis to 1L therapy was longer (median:32 vs 27 days), without OS penalty. PROs showed improved physical function at 6 months with treatment with matched targeted/IO regimens vs empiric chemotherapy.
CONCLUSIONS: Linked Medicare claims+EMR analysis enabled real-world integrated assessment of biomarker testing and targeted/IO uptake for advanced solid tumors. Nearly one-half: Biomarker testing; roughly one‑third: Biomarker‑matched 1L therapy, which was associated with improved 12‑month survival, supporting the benefit of broad NGS‑guided, targeted, and immunotherapy‑based strategies in routine practice.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PT6
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology