KNOWLEDGE AND PRACTICE PATTERNS AMONG PULMONOLOGISTS FOR MOLECULAR BIOMARKER TESTING IN ADVANCED NON-SMALL CELL LUNG CANCER

Abstract

SESSION TITLE: Lung Cancer Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Over the last decade, targeted agents for advanced stage non-small cell lung cancer (NSCLC) offer improved outcomes and survival for eligible patients. These therapies require testing for molecular biomarkers to assess eligibility and recent evidence suggests that testing is underutilized. Pulmonologists often perform endobronchial ultrasound (EBUS) to evaluate these patients and should be aware of indications for testing and obtain enough tissue for molecular biomarker analysis. In collaboration with The National Lung Cancer Roundtable of the American Cancer Society and CHEST, a survey of pulmonologists was performed to better understand barriers to testing. METHODS: The survey was developed by a group which included pulmonologists, thoracic surgeons, a radiologist, radiation oncologists, and an epidemiologist. Questions focused on respondent’s clinical volume, tissue sampling methods for patients with advanced stage NSCLC, responsible party for ordering molecular testing, and knowledge of available molecular biomarkers and approved targeted therapies. 7,238 pulmonologists in the CHEST analytic database were randomly sampled to receive the survey. RESULTS: 453 pulmonologists responded. Pulmonologists in academics center report seeing higher volumes of patients with advanced NSCLC per week than those in the community, 36% and 14% respectively. 87% report performing or referring for EBUS and about half (48%) perform EBUS themselves. 39 (14%) who perform EBUS obtain only 0-2 passes for molecular analysis, while 88 (31%) perform more than 5 passes. Responsible party for test ordering widely varied and 48% indicate having an institutional policy for testing. Presence of an institutional policy was associated with increased guideline awareness and higher rates of conducting molecular analysis. Rates of testing were high for EGFR and ALK, 99% and 95%, and lower for PD-L1, BRAF and ROS1, 77%, 44% and 48% respectively. Interventional pulmonologists and those in academic settings report higher rates of testing for biomarkers. For example, interventionalists test for BRAF and ROS1 nearly twice as often compared to generalists and those in an academic setting test 10-15% more often than those working in community settings (p<0.05). CONCLUSIONS: Our study suggests there is significant variation among pulmonologists in their practice acquiring tissue and awareness of and testing for molecular biomarkers in advanced NSCLC. This study suggests that pulmonologists should focus on knowledge for sending biomarkers and on obtaining adequate tissue for testing. Additionally, institutional policies correlate with higher rates of testing and may improve knowledge of available biomarkers for testing and treatment. CLINICAL IMPLICATIONS: Identifying and reducing barriers to molecular testing for patients with advanced stage NSCLC can improve access to treatment and outcomes in this population. DISCLOSURES: No relevant relationships by Upal Basu Roy, source=Web Response stockholder relationship with Merck Please note: $20001 - $100000 Added 03/09/2020 by Adam Fox, source=Web Response, value=Ownership interest stockholder relationship with MMM Please note: $20001 - $100000 Added 03/09/2020 by Adam Fox, source=Web Response, value=Ownership interest Consultant relationship with Biodesix Please note: $20001 - $100000 Added 05/31/2020 by James Jett, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with AstraZeneca Please note: $1-$1000 Added 06/26/2020 by Jennifer King, source=Web Response, value=to GO2 Foundation Speaker/Speaker's Bureau relationship with Foundation Medicine Please note: $1-$1000 Added 06/26/2020 by Jennifer King, source=Web Response, value=to GO2 Foundation Speaker/Speaker's Bureau relationship with ThermoFisher Please note: $1-$1000 Added 06/26/2020 by Jennifer King, source=Web Response, value=to GO2 Foundation Speaker/Speaker's Bureau relationship with Merck Please note: $1001 - $5000 Added 06/26/2020 by Jennifer King, source=Web Response, value=to GO2 Foundation Advisory Committee Member relationship with GRAIL Please note: $1-$1000 Added 06/26/2020 by Jennifer King, source=Web Response, value=Consulting fee No relevant relationships by Gerard Silvestri, source=Web Response No relevant relationships by Robert Smith, source=Web Response