A survey by the International Association for the Study of Lung Cancer (IASLC) has shown that although lung cancer biomarker testing rates have increased substantially since 2018, they remain suboptimal, particularly for patients with early-stage disease.
Cost, time, sample quality, access to testing, and a lack of awareness were the biggest barriers to testing, reported Matthew Smeltzer, PhD, associate professor of epidemiology and biostatistics at the University of Memphis School of Public Health, at the 2024 World Congress on Lung Cancer, held in San Diego this week.
He said that the IASLC is now launching a series of initiatives to target these barriers with the aim of further improving uptake.
In 2018, the IASLC surveyed physicians and researchers on biomarker testing practices for patients with lung cancer. At that time, just 39% of respondents estimated that more than half of individuals with lung cancer were biomarker tested in their country, even though biomarker status is vital to inform optimal care.
Since then, there have been numerous therapeutic advances, including treatments that have made biomarker testing relevant in early-stage lung cancer, rather than just late-stage disease.
The IASLC and partners therefore launched the second global survey on biomarker testing in spring of 2024.
The new survey evaluated changes in testing since the last survey, timely perspective on adopting or increasing next generation sequencing (NGS), and deeper insights into barriers to testing across diverse providers and health systems.
“Our goal is to use the data obtained to develop a resource guide on successful implementation of NGS testing,” said Smeltzer.
He reported that pre-survey focus groups that included medical oncologists, pathologists, pulmonologists, surgeons, epidemiologists, and advocacy partners showed a paradigm shift in attitudes toward biomarker testing. The consensus was that biomarker testing was no longer a “nice-to-have” but rather a “must have” for patients with lung cancer.
The final survey included sections on demographics, current practices and perceptions, pathology, ordering tests or treatment, acquiring tissue, barriers to optimal testing, and potential solutions.
Among the 1677 evaluable responses across 90 countries and 14 disciplines, most participants believed that biomarker testing significantly impacts outcomes (98.3%) and that they have a clear understanding of who should receive testing (91.2%).
Yet only 63.4% ranked it highly important to perform biomarker testing in late-stage disease, with just 29.4% giving the same ranking for early-stage disease.
Smeltzer thinks this may point to a disconnect between people thinking that biomarker testing helps people but not quite being on board with testing for everyone.
He added that the low number ranking testing highly important for early-stage disease was “concerning.” He said: “We would like everyone to think it’s highly important—especially testing for EGFR/ALK mutations in surgical patients.”
This “shows that there’s work to do,” said Smeltzer. “It’s an awareness issue, that testing is not valued nearly as much in early-stage disease.”
Although there is work to be done, 67% of respondents estimated that more than half of individuals with lung cancer are biomarker tested in their country, which is a significant improvement compared with the rate of 39% recorded in 2018 survey.
Just under half (43%) of participants said that they sometimes or often treat patients prior to receiving biomarker results. “This is not what we want to happen,” Smeltzer remarked. “It shows us that there is still a gap in actually getting the results in the hands of people that need to make treatment decisions in time.”
Indeed, the median tissue testing turnaround time was 14 days. There was no consensus on where delays occurred, but people thought there was an opportunity to speed up the time between sample processing and molecular analysis.
Cost was cited as the most common barrier to testing, with 27.2% of respondents suggesting it is a problem. Suggestions for overcoming cost barriers included working with policy makers to mandate or incentivize full reimbursement, educating decision makers on the cost effectiveness of biomarker testing and setting up innovative cost-sharing agreements. The IASLC has initiated a separate project to carry out a deeper analysis on cost issues by region to help guide future efforts with policy makers and payers.
The organization is also launching a series of initiatives based on the study findings to target awareness, processes, quality, and policy.
These include updating the joint College of American Pathologists, IASLC, and Association for Molecular Pathology guidelines on molecular testing for lung cancer and disseminating the current study findings through a published manuscript as well as fliers and presentations at regional meetings.
A new partners project has been set up to develop a multidisciplinary consensus recommendation on lung sampling to improve quality of sample collection, while a recently launched Global Policy and Partnerships committee will work on policy issues across thoracic cancer care including biomarker testing.
