OBJECTIVES: The treatment of NSCLC has been undergoing a shift the past several years in the United States due to several forces --- first, the introduction of highly anticipated checkpoint inhibitors that have demonstrated markedly improved outcomes but that also come at greater cost. Second, the overall healthcare trend towards value based care with a focus on improved quality and efficiency. This study quantified utilization of biomarker testing and checkpoint inhibitors in NSCLC in the community oncology setting.

METHODS: Integra Connect utilized multi-year, community oncology practice sites Medicare Fee for Service (FFS) paid claims and Electronic Health Record (EHR) from Medicare and non- Medicare patient data to identify NSCLC patients by cancer stage as well as chemotherapy regimen. Patients were categorized by stage, presence or absence of genetic testing, genetic results if tested, treatment (chemotherapy and/or immunotherapy), line of therapy, and reasons for treatment discontinuation to evaluate utilization. Data sourced from both Medicare claims and EHR were used to compare rates of biomarker testing and utilization of newer immunotherapy treatments.

RESULTS: Among Medicare beneficiaries with a NSCLC diagnosis from July 2016 through June 2017, 20% of patients received biomarker testing (EGFR, ALK, KRAS, PD-L1) based on paid claims data. This testing rate remained relatively constant over the study period. Over the same period, based on EHR data, immunotherapy utilization increased from 10% of 1^st line NSCLC patients to 18%, and nearly 50% of second line NSCLC patients.

CONCLUSIONS: Our study found a flat trend in biomarker testing rates in conjunction with increasing rates of immunotherapy utilization. These results highlight the need for building consensus among providers regarding the utility of biomarker testing and the potential impact testing has on more informed treatment selection - ensuring patients that are likely to benefit from immunotherapy receive appropriate treatment.