Expert Discusses Disparities in Biomarker Testing for NSCLC

In a Pharmacy Times interview at the American Society of Clinical Oncology Annual Meeting 2022 Nicholas Robert, MD, chief medical officer at Ontada, discussed disparities in biomarker testing and how they are being addresses.

Q: What does access to biomarker testing look like for patients?

Nicholas Robert: Although biomarkers are part of the guideline recommendations by NCCN, they're not done always, and what we found 2 years ago, is that it was done about 45% of the time. It’s better, now, we've had an update, so we're doing barn biomarkers more often than before. This was in the area of metastatic non–small cell lung cancer, but the recent report that was presented at ASCO this year, is really looking at the indicators: what are the indicators for testing?

We found, not a surprise, that in patients that have a certain type of metastatic non–small cell lung cancer non squamous there's more testing, and why it's not surprising is that’s where the biomarkers started in that type of lung cancer.

We also found that patients that were seen in larger practices were more patients seen with lung cancer and had more testing. Then we found that certain regions of the country, the south in particular, have less testing, and African Americans have less testing.

The importance of finding this is that we now know where to try to improve testing. I should say, there should be general increased improvement testing everywhere. It's not that there's any one area that's doing a great job, and that's been part of this effort called MYLUNG, which is a consortium effort working with the medical oncologists and other cancer doctors in US oncology, and working with support from pharma, to look at testing in not in metastatic non–small cell lung cancer, and actually beginning to look at testing and earlier forms of lung cancer.

The whole focus is to increase testing because we know that if the testing is increased, we'll do a better job identifying the patients that can be treated with more appropriate treatment, so-called targeted therapy when that's appropriate. That's the whole motive behind this program.

Q: What patient characteristics did you examine for the study, and why were these selected?

Nicholas Robert: We looked at a number of factors, in terms of who was getting tested and including that stage of diagnosis, gender, age, other factors, but we did find is that there were 4 variables in a multivariable predictive model that identify patients, and those were patients that have certain histology, so called non squamous histology, those patients had a higher rate of testing, and patients that we're seeing in practices that see more lung cancer had higher rates.

Then we did find it, in certain regions of the country, there was less testing in the south. We don't have a good explanation for that. There could be a number of reasons. Then we also found less testing and African Americans.

Q: Do you have any insight into why specific predictors were associated with lower rates of biomarker testing?

Nicholas Robert: I think there's a number of factors. There's one of awareness, although we have an EMR in US oncology that has prompts to encourage reporting results. There can be barriers to testing, financial barriers to testing where it may not be covered by insurance. That could be a concern. There may be a sense of urgency to start treatment and not do all the testing.

We feel it's multifactorial, but I think the exciting part of the story is we have this MYLUNG Consortium, which is completely focused on improving testing. So what we found from our study that we presented last year was around 45%,for all 5 markers being tested. Now there are 10 markers.

It's even a greater challenge, but we're finding that the testing is improving, but we will be doing studies in the future, through MYLUNG, looking at certain interventions to see if we can improve testing, and the results of this year's work identified some of the factors that lead to less testing. We now can concentrate on how we can improve on that.