Barries in precision medicine implementation among Advanced Nonsquamous Cell Lung Cancer-patients: A Real-World-Evidence Scenario

Abstract

BACKGROUND Precision oncology has a prominent role in nonsquamous non-small cell lung cancer (nsNSCLC) treatment progress. This study aimed to investigate not-cost-related factors involved in the use of the molecular profile in clinical practice and the influence of its availability on clinical decisions. METHODS nsNSCLC patients who underwent molecular testing in a private referral Brazilian center were identified. The primary endpoint was the interval from the diagnosis of advanced nsNSCLC to the characterization of the molecular profile. Other outcomes, focusing on the biomarker tissue journey, were also assessed, as well as the choice of therapy and changes in the treatment upon the testing results. RESULTS In this cohort (n = 78), the median time between the advanced nsNSCLC diagnosis and biomarker characterization was 40.5 days (range, 29.5–68.5). The median interval between the diagnosis and the test request was longer than the interval between the request and the results (respectively 29.0 versus 12.0 days; p < 0.001). At the treatment initiation, 51% (36/71) of the patients did not have their full driver mutations panel results available. Of these, 42% (15/36) had a targetable alteration identified later on. Among patients harboring a targetable alteration, only 46% (n = 13/28) received a tyrosine kinase inhibitor (TKI) as first-line therapy. The median time to the TKI initiation was even longer than the median time to all treatment initiation (92.0 versus 40.0 days). CONCLUSIONS Our data show a long median time from advanced nsNSCLC diagnosis and the availability of the biomarker testing in medical practice, which impacted the choice of a non-personalized therapy as the first-line and the necessity of treatment changes after the final report.