First-line treatment that aligns with the results of biomarker testing and treatment guidelines is linked with better survival outcomes in patients with advanced or metastatic NSCLC (a/mNSCLC), according to a study published in the Journal of the National Comprehensive Cancer Network.
The study authors examined overall survival (OS) by biomarker testing status and by receipt of guideline-concordant therapy in a large, real-world, retrospective cohort study of patients with a/mNSCLC in the United States.
Researchers used an a/mNSCLC database obtained from real-world EHR. Patients included in the study (n=21,572) had a diagnosis of nonsquamous a/mNSCLC and initiated first-line therapy on or after January 1, 2015. The median age was 69 (IQR, 61-76) with a follow-up of 9.5 months (IQR, 3.5-21.5).
Adjusted Hazard of Death Is 30% Higher in Patients Who Never Received Testing
OS, which was determined using Kaplan-Meier analysis, was defined as the number of months from the initiation of first-line therapy to the date of death or end of follow-up. Researchers conducted multivariable Cox proportional hazard modeling to compare OS between groups, adjusting for baseline covariates; adjusted HRs were also recorded.
The study team noted that 88% of all patients were evaluated for at least one biomarker. A total of 69% of these patients received testing before or at the start of first-line treatment.
They observed that the adjusted hazard of death was 30% higher in patients who never (vs ever) received biomarker testing in the database (HR, 1.30; 95% CI, 1.24-1.37), and 12% higher in patients who did not receive (vs did receive) biomarker testing before or at the start of first-line treatment (HR, 1.12; 95% CI, 1.08-1.16). Among patients who did not receive guideline-concordant first-line treatment (vs those who did) after having a biomarker-positive disease (HR, 1.25; 95% CI, 1.13-1.40), the adjusted hazard of death was 25% higher.
“Comprehensive Biomarker Testing Is Critical to Improving Long-Term Survival”
These findings, they stated, suggest that receiving first-line treatment that is “concordant with biomarker testing results and national treatment guidelines is associated with improved survival outcomes in patients with a/mNSCLC,” the study authors wrote. “Strengths of this study include the evaluation of both the timing of biomarker testing and the first-line treatments received and quantification of their association with OS. In the clinical landscape of a/mNSCLC, which is rapidly evolving with a growing list of FDA-approved targeted therapies, the upfront use of comprehensive biomarker testing is critical to improving long-term survival.”