Evaluation of molecular testing patterns in metastatic non-small cell lung cancer at a large U.S. health plan.

MacLean, Elizabeth; Louder, Anthony; Saverno, Kim; Smith, Gregory L.; Mardekian, Jack; C, Bruins; Ward, Melea; Sweetman, Robert; Pasquale, Margaret K.

doi:10.1200/jco.2014.32.15_suppl.e19075

Cited by 12 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are consistent with studies that have noted that Medicaid and uninsured patients with NSCLC and other cancers are less likely to receive recommended treatments than patients with private insurance (20,(31)(32)(33)(34). Our findings also are consistent with two studies that found fewer patients with NSCLC with public insurance received molecular testing or TKIs compared with patients with private insurance (9,35). However, because TKI use is restricted to patients with certain mutations (EGFR, ALK, ROS1; refs.…”

Section: Discussionsupporting

confidence: 91%

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Maguire

Morris

Parikh‐Patel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

Background: Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear.Methods: Using California Cancer Registry data (2012-2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields.Results: A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare-Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments.Conclusions: Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts.Impact: Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.

show abstract

Section: Discussionsupporting

confidence: 91%

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Maguire

Morris

Parikh‐Patel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

show abstract

“…6 Barriers to testing identified by US and global surveys include insufficient tissue for testing, relatively long turnaround times (TATs), lack of local molecular testing, and poor performance status of patients. [7][8][9][10][11][12][13][14][15][16][17][18] Given the growing number of actionable targets in NSCLC, current guidelines 2 support the position that upfront comprehensive next-generation sequencing (NGS) is more practical than performing a series of single-gene assays. Recent advances in checkpoint immunotherapy further underscore the need for more comprehensive NGS testing to accurately assess new markers, such as tumor mutation burden, mutational signatures, and microsatellite instability.…”

Section: Introductionmentioning

confidence: 99%

Ultrarapid EGFR Mutation Screening Followed by Comprehensive Next-Generation Sequencing: A Feasible, Informative Approach for Lung Carcinoma Cytology Specimens With a High Success Rate

Arcila

Yang

Momeni

et al. 2020

JTO Clinical and Research Reports

View full text Add to dashboard Cite

Introduction: For patients with advanced NSCLC, cytologic samples may be the only diagnostic specimen available for molecular profiling. Although both rapid and comprehensive assessment are essential in this setting, an integrated multitest approach remains an important strategy in many laboratories, despite the risks and challenges when working with scant samples. In this study, we describe our experience and high success rate in using a multitest approach, focusing on the clinical validation and incorporation of ultrarapid EGFR testing using the Idylla system followed by comprehensive next-generation sequencing (NGS). Methods: Cytology samples received for routine molecular testing were included in this study. The performance characteristics of the EGFR Idylla assay were assessed; tissue suitability parameters and interpretation criteria to supplement automated mutation calling were established. The assay performance was monitored for 1 year, comparing the results with those of concurrent NGS testing by MSK-IMPACT (primarily) or MSK-AmpliSeq and MSK-Fusion solid panel in a subset of cases.

show abstract

“…While EGFR testing rates have increased over time, still not all eligible patients receive testing. A study evaluating NSCLC patients seen in community medical oncology practices in New Jersey and Maryland showed between 2013 to 2015, 59% of eligible patients were tested for EGFR mutations, while a second study using data from a national, private health insurance company found testing rates to be around 61% between the years of 2010 to 2012 [19,20]. In comparison, testing rates in Kentucky were substantially lower during this same time period, with 7% of eligible patients tested in 2010 and 12% tested in 2011, highlighting disparities between urban, privately insured individuals and rural, Medicare recipients.…”

Section: Discussionmentioning

confidence: 99%

EGFR testing and erlotinib use in non-small cell lung cancer patients in Kentucky

et al. 2020

View full text Add to dashboard Cite

This study determined the frequency and factors associated with EGFR testing rates and erlotinib treatment as well as associated survival outcomes in patients with non small cell lung cancer in Kentucky. Data from the Kentucky Cancer Registry (KCR) linked with health claims from Medicaid, Medicare and private insurance groups were evaluated. EGFR testing and erlotinib prescribing were identified using ICD-9 procedure codes and national drug codes in claims, respectively. Logistic regression analysis was performed to determine factors associated with EGFR testing and erlotinib prescribing. Cox-regression analysis was performed to determine factors associated with survival. EGFR mutation testing rates rose from 0.1% to 10.6% over the evaluated period while erlotinib use ranged from 3.4% to 5.4%. Factors associated with no EGFR testing were older age, male gender, enrollment in Medicaid or Medicare, smoking, and geographic region. Factors associated with not receiving erlotinib included older age, male gender, enrollment in Medicare or Medicaid, and living in moderate to high poverty. Survival analysis demonstrated EGFR testing or erlotinib use was associated with a higher likelihood of survival. EGFR testing and erlotinib prescribing were slow to be implemented in our predominantly rural state. While population-level factors likely contributed, patient factors, including geographic location (areas with high poverty rates and rural regions) and insurance type, were associated with lack of use, highlighting rural disparities in the implementation of cancer precision medicine.

show abstract

Evaluation of molecular testing patterns in metastatic non-small cell lung cancer at a large U.S. health plan.

Cited by 12 publications

References 0 publications

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Ultrarapid EGFR Mutation Screening Followed by Comprehensive Next-Generation Sequencing: A Feasible, Informative Approach for Lung Carcinoma Cytology Specimens With a High Success Rate

EGFR testing and erlotinib use in non-small cell lung cancer patients in Kentucky

Contact Info

Product

Resources

About