Oncologists Still Failing 'Woefully' at Molecular Testing in Lung Cancer

Two years ago, I wrote about data showing a humbling gulf between our knowledge of molecular marker testing and our delivery of targeted therapies for advanced lung cancer. Since then, we have seen very few analyses updating the state of play, leaving us with a glimmer of hope that the oncology community is putting precision medicine into action.

But, sadly, two new analyses reveal that we're still doing a woefully poor job of offering molecular testing to our patients with advanced non–small cell lung cancer (NSCLC).

New Data

In a recent retrospective chart review from the US Oncology Network, researchers highlighted how little molecular testing in advanced lung cancer has improved. The analysis included 3474 patients with advanced NSCLC, 81% with nonsquamous histology, who underwent a workup within the 2-year period between 2018 and 2020. The investigators focused on rates of testing for PD-L1, EGFR, ALK, ROS1, and BRAF-V600E, which aside from PD-L1 all have one or more FDA-approved, and National Comprehensive Cancer Network (NCCN)-recommended, targeted therapies.

While a charitable interpreter of the results could take heart in the fact that 90% of the patients with advanced NSCLC underwent testing for at least one biomarker (most commonly PD-L1), it was disappointing to see that only 46% patients overall, and 49% of those with nonsquamous NSCLC, received testing for all five clinically relevant biomarkers.