Biomarker testing patterns among patients newly diagnosed with metastatic non-small cell lung cancer, prostate cancer, and bladder cancer
Siraje Mahmud, Lisa Dwyer Orr, Mika Cline, Ayda Mirsalehi, Monica Lisi, Laura Ensley, Lorraine Brisbin, R Steven PaulsonAbstract
Background
National clinical guidelines recommend biomarker testing to identify actionable alterations across cancers, supporting personalized treatment.
Methods
This retrospective database study characterized biomarker testing patterns among adult patients newly diagnosed with metastatic non-small cell lung cancer (NSCLC), prostate cancer, or bladder cancer (January 2018–December 2022), receiving care within a large regional community oncology network in the West South-Central United States.
Results
Of 18 491 patients with NSCLC, 20 810 with prostate cancer, and 4120 with bladder cancer, 7383 (40%), 4985 (24%), and 888 (22%), respectively, had metastatic disease. For these metastatic subgroups, biomarker testing rates were 80% (NSCLC), 34% (prostate), and 42% (bladder). Median time from disease diagnosis to first test order was 10 days (NSCLC), 98 days (prostate), and 23 days (bladder), with differences observed across racial and ethnic groups. Among tested patients, actionable mutations were identified in 29% (NSCLC), 25% (prostate), and 14% (bladder) of patients, and targeted therapy was received by 54%, 15%, and 38% of these patients, respectively. Among patients who initiated treatment prior to receipt of test results, 72% (NSCLC), 12% (prostate), and 30% (bladder) subsequently switched to targeted therapy following a positive result. Testing rates increased between 2018 and 2022 for all cohorts; result turnaround times improved in prostate and bladder cancers.
Conclusions
Biomarker testing was highest in metastatic NSCLC and lower in prostate and bladder cancer in this community oncology setting. Despite improvements over time, gaps remain in timely testing and use of targeted therapies, highlighting opportunities to optimize precision oncology implementation.