Biomarker Guided Treatment in Non-Small Cell Lung Cancer (NSCLC): Adherence to NCCN Guidelines, and Outcomes in a US-Based Population
Author(s)
Emechebe N, Tiwana S, Kamalakar R, Khandelwal N
AbbVie, Mettawa, IL, USA
Presentation Documents
OBJECTIVES : Real-world data on the frequency of biomarker testing, its influence on treatment decision making, and subsequent clinical outcomes in NSCLC is limited. This study aims to describe treatment patterns and clinical outcomes among patients who tested positive and received biomarker-guided therapy. METHODS : This retrospective cohort study included patients with advanced/metastatic non-squamous NSCLC from ConcertAI structured EHR database between January 1, 2017 and December 31, 2020. Patients were required to have at least 30 days of activity in the database, and at least one line of therapy. Biomarkers assessed prior to first-line initiation included EGFR, ALK, and PD-L1. Patients were classified as NCCN guideline-adherent if, upon a positive test result, they received biomarker-guided therapy. Log rank test and multivariable Cox proportional hazard models were employed to compare median overall survival (OS) and time to next treatment or death (TTNT-D) between guideline-adherent and nonadherent patients. RESULTS : 2,428 eligible patients were identified during the study period with a median follow-up of 11.2 months and average age at diagnosis of 66.2 (+10.6) years. Testing rates as reported in this structured EHR database prior to first-line treatment were 31.9%, 31.2%, and 27.3% for PD-L1, EGFR, and ALK. Among tested patients, positivity rate was 52.7%, 23.1%, and 4.5%, respectively. Majority of biomarker-positive patients received biomarker-guided therapy in first line: EGFR (75.5%), ALK (81.8%), and PD-L1 (67%). Guideline-adherent, EGFR-positive patients had reduced risk of TTNT-D and mortality compared to nonadherent patients {mTTNT-D 10.7 vs. 2.8 months, p<0.0001; Hazard ratio (HR) (95% CI) 0.3 (0.19, 0.47) and mOS 22.3 vs 17 months, p=0.19; HR (95% CI) 0.65 (0.39, 1.1)}. CONCLUSIONS : Overall, receipt of biomarker-guided therapy was high and associated with improved clinical outcomes. These findings highlight the benefit of adhering to NCCN recommended biomarker guided therapies in NSCLC.
Conference/Value in Health Info
2021-11, ISPOR Europe 2021, Copenhagen, Denmark
Value in Health, Volume 24, Issue 12, S2 (December 2021)
Code
POSC241
Topic
Health Service Delivery & Process of Care
Topic Subcategory
Treatment Patterns and Guidelines
Disease
Oncology, Personalized and Precision Medicine