General medical oncologists assessment and use of targeted treatment for patients (pts) with metastatic nonsquamous non-small cell lung cancer (nsqNSCLC).

Abstract

e18186 Background: Current guidelines endorse biomarker assessment for all pts with nsqNSCLC. However, variability in actualizing these recommendations may exist. This pilot project evaluated how MO in a large practice group approach mutation analysis and targeted treatment in nsqNSCLC, both hypothetically and in real pts. Methods: In fall 2016, 10 MO from Florida Cancer Specialists each provided information on biomarkers assessed and therapies administered for 10 nsqNSCLC pts(5 without an identified target and 5 with tumor driver mutations). A survey evaluating general practice patterns was also executed. IRB exemption was obtained and a modest honorarium was provided. Results: All MO reported that ideally all nsqNSCLC pts should be tested for EGFR mutations (EGFRm) and ALK rearrangement (ALKr) but only half stated that they would recommend next-generation sequencing (NGS). Of the 54 pts without a mutation, 52 (96%) had EGFRm and ALKr testing but only 12 (22%) had undergone NGS. Among the 45 pts with an actionable target, 41 (91%) had EGFRm and 4 (9%) had ALKr. 37 (80%) of these pts received first-line TKIs, and all MO agreed they would typically recommend this approach. 8 (20%) EGFRm pts initially received chemotherapy, 5 because the MO and/or pt preferred immediate treatment. All MO indicated that EGFRm pts progressing on first-line EGFR TKIs should be evaluated for T790M and indeed 9 pts with disease progression on an EGFR TKI since November 2015 had undergone plasma or tissue testing, and of these 5 are currently receiving osimertinib. Conclusions: The self-stated and actual practice patterns of MO related to nsqNSCLC biomarker assessment largely adhere to current guideline recommendations, but the limited use of NGS suggests that many pts with potentially targetable mutations other than EGFRm and ALKr are not being identified. These findings support growing evidence that interrogation of case-level data can elucidate practice gaps, and an integrated CME platform is being developed to assess whether discussion of documented deficiencies can enhance quality of care.