REAL-WORLD ROS1 TESTING IN FIRST-LINE NON-SMALL CELL LUNG CANCER
Author(s)
Raja Mudad, MD1, Rushir Choksi, MD2, Taral Patel, MD3, Brian P Mulherin, MD4, Eric Schaefer, MD4, John Rhee, MD2, Fred Kudrik, MD5, Felice Yang, MPH6, Steven W. Champaloux, MPH, PhD6, Don Parris, MPH, PhD6, Melissa Rammage, PharmD, MS, BCOP6, Lindsay Aton, MHSA6, Mike Gart, MBA6, Brandon Wang, MBA6, Prateesh Varughese, PharmD, MBA6, Jeffrey Scott, MD6.
1University of Miami Health System, Miami, FL, USA, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 3Zangmeister Cancer Center, Columbus, OH, USA, 4Hematology Oncology of Indiana, Indianapolis, IN, USA, 5South Carolina Oncology Associates, Columbia, SC, USA, 6PrecisionQ, IntegraConnect, West Palm Beach, FL, USA.
1University of Miami Health System, Miami, FL, USA, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 3Zangmeister Cancer Center, Columbus, OH, USA, 4Hematology Oncology of Indiana, Indianapolis, IN, USA, 5South Carolina Oncology Associates, Columbia, SC, USA, 6PrecisionQ, IntegraConnect, West Palm Beach, FL, USA.
OBJECTIVES: Biomarker testing is critical for guiding oncology patient care. This study describes real-world patterns of ROS1 testing in patients with metastatic non-small cell lung cancer (mNSCLC), for which NCCN Guidelines recommend RNA next-generation sequencing (NGS) in 2022.
METHODS: Adults diagnosed with mNSCLC on/after 01-Oct-2017 through 31-Aug-2025 were identified from the Integra PrecisionQ database. Metastatic status and biomarker information were verified through manual chart review of clinical notes and genomic/pathology reports. ROS1 abstraction included genomic panel type and test result.
RESULTS: Of 12,540 curated patients, 11,333 (90%) received a biomarker test and 10,124 (81%) were tested for ROS1. Mean age and race did not differ by ROS1 testing status, but females were slightly more likely to be tested. Among 10,124 ROS1-tested patients, 7,552 (75%) received a DNA-based test and 1,461 (14%) received an RNA NGS test; overall, 3,452 (34%) received any hybridization test. Most ROS1-tested patients (7,881/10,124, 78%) had a result before starting mNSCLC first-line therapy (m1L), and 141 (1.4%) were ROS1-positive. Of 141 ROS1-positive patients, 132 initiated m1L therapy and 109 of those patients (83%) began treatment after a confirmed positive result (median of 23 days from test result to treatment). ROS1 tyrosine kinase inhibitors (TKIs) were used in m1L in 40% (44/109) of patients. The remaining 65 patients received chemotherapy, immunotherapy, or non-ROS1 TKIs, including 13 who utilized an EGFR TKI and had an identified EGFR co-mutation. Of the 65 patients who did not receive ROS1 TKI in m1L, 8 received a ROS1 TKI in a later line of therapy.
CONCLUSIONS: In this real-world mNSCLC cohort, 81% received ROS1 testing, but only 14% received NCCN guideline-recommended RNA NGS. Among ROS1-positive patients, fewer than half received a ROS1-targeted TKI. These findings highlight opportunities for broader adoption of guideline-recommended testing to ensure appropriate use of targeted therapies and maximize benefits of emerging ROS1 treatments.
METHODS: Adults diagnosed with mNSCLC on/after 01-Oct-2017 through 31-Aug-2025 were identified from the Integra PrecisionQ database. Metastatic status and biomarker information were verified through manual chart review of clinical notes and genomic/pathology reports. ROS1 abstraction included genomic panel type and test result.
RESULTS: Of 12,540 curated patients, 11,333 (90%) received a biomarker test and 10,124 (81%) were tested for ROS1. Mean age and race did not differ by ROS1 testing status, but females were slightly more likely to be tested. Among 10,124 ROS1-tested patients, 7,552 (75%) received a DNA-based test and 1,461 (14%) received an RNA NGS test; overall, 3,452 (34%) received any hybridization test. Most ROS1-tested patients (7,881/10,124, 78%) had a result before starting mNSCLC first-line therapy (m1L), and 141 (1.4%) were ROS1-positive. Of 141 ROS1-positive patients, 132 initiated m1L therapy and 109 of those patients (83%) began treatment after a confirmed positive result (median of 23 days from test result to treatment). ROS1 tyrosine kinase inhibitors (TKIs) were used in m1L in 40% (44/109) of patients. The remaining 65 patients received chemotherapy, immunotherapy, or non-ROS1 TKIs, including 13 who utilized an EGFR TKI and had an identified EGFR co-mutation. Of the 65 patients who did not receive ROS1 TKI in m1L, 8 received a ROS1 TKI in a later line of therapy.
CONCLUSIONS: In this real-world mNSCLC cohort, 81% received ROS1 testing, but only 14% received NCCN guideline-recommended RNA NGS. Among ROS1-positive patients, fewer than half received a ROS1-targeted TKI. These findings highlight opportunities for broader adoption of guideline-recommended testing to ensure appropriate use of targeted therapies and maximize benefits of emerging ROS1 treatments.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD88
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology