BIOMARKER-DRIVEN TREATMENT PATTERNS AND GUIDELINE CONCORDANCE IN ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC): REAL-WORLD EVIDENCE FROM NORSTELLALINQ CLAIMS AND EHR DATA
Author(s)
Isabella Even-Chen, BA1, ilan behm, MPH2, Rahul Das, PhD3, Atharva Manjrekar, MS4, Woojun Daniel Park, PhD5, Allison Perry, PhD1.
1Norstella, New York, NY, USA, 2Norstella, Englewood, CO, USA, 3Norstella, Yardley, PA, USA, 4Norstella, West Hartford, CT, USA, 5Norstella, Houston, TX, USA.
1Norstella, New York, NY, USA, 2Norstella, Englewood, CO, USA, 3Norstella, Yardley, PA, USA, 4Norstella, West Hartford, CT, USA, 5Norstella, Houston, TX, USA.
OBJECTIVES: To characterize real-world regimen selection by EGFR mutation subtype and PD-L1 expression level in NSCLC, and to assess guideline-concordant therapy adoption in biomarker-positive patients.
METHODS: Using NorstellaLinQ’s US real-world linked open claims, structured EHR, and clinical notes (January 2019-present), treatment regimen distribution was assessed across lines of therapy among NSCLC patients with documented EGFR (N=16,093 tested) or PD-L1 (N=29,444 tested) status prior to line 1. Regimens were categorized as EGFR TKI monotherapy, TKI-plus-targeted, chemoimmunotherapy, CPI monotherapy, platinum doublet, and other, and compared across EGFR subtypes and PD-L1 expression levels; guideline concordance was assessed by biomarker-matched versus non-matched regimen receipt.
RESULTS: Among Exon 19 and 21 mutation-positive patients (N=1,153 combined), over 80% received an EGFR TKI in line 1, consistent year-over-year. A measurable proportion of EGFR-positive patients received chemotherapy-only regimens in line 1. Among Exon 20 insertion patients, over one-quarter received amivantamab-plus-chemotherapy in line 1. EGFR-negative or untested patients relied predominantly on chemotherapy or chemoimmunotherapy. Among PD-L1-high patients, pembrolizumab monotherapy was the most common first-line approach; PD-L1-low and unknown/negative patients relied more heavily on platinum doublet-based regimens. Among KRAS-tested patients, G12C-positive patients showed increasing TKI use across lines (4% in line 1 to 17% in line 3), while G12D patients received no KRAS-targeted therapy across any line. Approximately 60% discontinued by line 2.
CONCLUSIONS: EGFR mutation subtype and PD-L1 expression produce distinct real-world treatment patterns, with guideline-concordant therapy most consistently observed in Exon 19/21-positive and PD-L1-high patients. Persistent chemotherapy use among biomarker-positive patients signals incomplete adoption of precision approaches. These findings are directly relevant for HTA submissions and coverage policies evaluating biomarker-guided therapy access in NSCLC.
METHODS: Using NorstellaLinQ’s US real-world linked open claims, structured EHR, and clinical notes (January 2019-present), treatment regimen distribution was assessed across lines of therapy among NSCLC patients with documented EGFR (N=16,093 tested) or PD-L1 (N=29,444 tested) status prior to line 1. Regimens were categorized as EGFR TKI monotherapy, TKI-plus-targeted, chemoimmunotherapy, CPI monotherapy, platinum doublet, and other, and compared across EGFR subtypes and PD-L1 expression levels; guideline concordance was assessed by biomarker-matched versus non-matched regimen receipt.
RESULTS: Among Exon 19 and 21 mutation-positive patients (N=1,153 combined), over 80% received an EGFR TKI in line 1, consistent year-over-year. A measurable proportion of EGFR-positive patients received chemotherapy-only regimens in line 1. Among Exon 20 insertion patients, over one-quarter received amivantamab-plus-chemotherapy in line 1. EGFR-negative or untested patients relied predominantly on chemotherapy or chemoimmunotherapy. Among PD-L1-high patients, pembrolizumab monotherapy was the most common first-line approach; PD-L1-low and unknown/negative patients relied more heavily on platinum doublet-based regimens. Among KRAS-tested patients, G12C-positive patients showed increasing TKI use across lines (4% in line 1 to 17% in line 3), while G12D patients received no KRAS-targeted therapy across any line. Approximately 60% discontinued by line 2.
CONCLUSIONS: EGFR mutation subtype and PD-L1 expression produce distinct real-world treatment patterns, with guideline-concordant therapy most consistently observed in Exon 19/21-positive and PD-L1-high patients. Persistent chemotherapy use among biomarker-positive patients signals incomplete adoption of precision approaches. These findings are directly relevant for HTA submissions and coverage policies evaluating biomarker-guided therapy access in NSCLC.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD129
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Oncology