Clinicians Still Unaware of Need for Genetic Testing in NSCLC

Medscape Medical News
29 May, 2020 ,

An international survey sent to clinicians who treat nonsmall cell lung cancer (NSCLC) has found that one third were unaware of evidence-based guidelines that recommend targeted therapies when a driver mutation is identified. Moreover, the majority of these clinicians believe that fewer than 50% of patients in their country undergo molecular testing, the same survey showed. The survey was conducted by the International Association for the Study of Lung Cancer (IASLC); 2537 questionnaires from 102 countries were returned and analyzed. It was published online May 20 in the Journal of Thoracic Oncology.

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An international survey sent to clinicians who treat nonsmall cell lung cancer (NSCLC) has found that one third were unaware of evidence-based guidelines that recommend targeted therapies when a driver mutation is identified.

Moreover, the majority of these clinicians believe that fewer than 50% of patients in their country undergo molecular testing, the same survey showed.

The survey was conducted by the International Association for the Study of Lung Cancer (IASLC); 2537 questionnaires from 102 countries were returned and analyzed.

It was published online May 20 in the Journal of Thoracic Oncology.

The results are concerning because "the risk of death for patients with NSCLC is substantially reduced when a gene alteration is identified and the available targeted therapy is administered," the authors emphasize.

"Specific protocols to initiate reflex testing for guideline-recommended molecular markers would help providers consider molecular testing earlier and optimize tissue," they suggest.

Surprised That Clinicians Were Unaware of Guidelines

"I was not surprised that we found suboptimal testing rates based on other research that has demonstrated the need to improve the quality of lung cancer in some areas," the corresponding author Matthew Smeltzer, Ph.D., University of Memphis, Tennessee, told Medscape Medical News in an email.

"However, I was surprised that so many respondents were unaware of guidelines," he said.  

The College of American Pathologists, IASLC, and Association for Molecular Pathology established evidence-based standards for the selection of NSCLC patients for molecular testing in 2013, and these guidelines were subsequently endorsed by the American Society of Clinical Oncology.

"We suspect that the level of access a provider has to targeted therapies do affect molecular testing rates," Smeltzer acknowledged. 

Molecular Testing Survey

"The survey included a seven-question introduction for all respondents and then divided respondents into one of three tracks," the authors explain.

These tracks included respondents who requested tests and who treated patients (medical oncologists), those who analyzed and interpreted assays (pathologists), and those who acquired tissue samples (surgeons, pulmonologists, radiologists).

Countries were also grouped into five geographic regions — Asia, Europe, Latin America, the United States, and Canada — and the rest of the world (ROW).

"Overall, respondents reported that molecular testing rates were lower than we would like but they were not satisfied with the current state of testing, and they reported higher testing rates in their own clinics," Smeltzer noted.

However, when tests were ordered, "we found 99% of respondents in the requesting/treating track ordered tests for EGFR, 95% for ALK, 79% for ROS1, and < 50% ordered other tests," the authors observe.