A quality initiative focused on biomarker testing in stage IB-IIIA resected and stage IV non-small cell lung cancer patients.

Abstract

e13563 Background: The NCCN guidelines recommend non-small cell lung cancer (NSCLC) patients (pts) who are stage IB-IIIA (E-Stg) who have been resected to undergo EGFR testing and for stage IV pts to receive comprehensive biomarker testing that includes evaluating for EGFR, ALK, ROS1, RET, MET, NTRK1/2/3, KRAS, ERBB2, BRAF, and PD-L1. The American Oncology Network (AON) conducted a quality initiative (QI) with IntegraConnect PrecisionQ to assess the rates of EGFR testing in E-stg resected pts, rates of EGFR testing in stage IV pts, time of EGFR test result prior to treatment in Stage IV pts, and full NGS testing including all recommended biomarkers for Stage IV pts. This QI focused on interventions to optimize testing in these pts. We aim to show improvement in testing after implementation of the QI in pts with NSCLC at AON. Methods: Pts from the seven largest cancer centers within AON were randomly selected for the baseline analysis. There were 238 E-Stg pts in the baseline cohort that underwent resection between 1/1/2021 and 7/31/2023 and 348 stage IV pts in the baseline cohort received first-line treatment between 1/1/2021 to 7/31/2023. The baseline data was reviewed with AON clinical leadership in November of 2023 and findings were shared with the network via email communication in December of 2023. In the post-baseline, we evaluated 61 E-Stg pts and 69 stage IV pts between 1/1/2024 and 7/31/2024. Descriptive analyses were performed comparing baseline to post-baseline results. Results: The baseline cohort of E-Stg resected pts comprised of 71 (29.8%) stage IB, 22 (9.2%) stage IIA, 77 (32.5%) stage IIB, and 67 (28.2%) stage IIIA. The post-baseline cohort of E-Stg resected pts comprised of 16 (26.2%) stage IB, 6 (9.8%) stage IIA, 23 (37.7%) stage IIB, and 16 (26.2%) stage IIIA. Among the baseline cohort of E-Stg resected pts 68.5% were tested for EGFR mutations whereas among the post-baseline cohort 86.9% were tested for EGFR mutations. Among the baseline cohort of stage IV pts 94.5% were tested for EGFR mutations whereas among the post-baseline cohort 94.2% were tested for EGFR mutations. Among the baseline cohort of stage IV pts 71.0% received their EGFR test results prior to initiating their first line treatment whereas among the post-baseline cohort 78.3% received their EGFR test results prior to initiating their first line treatment. Among the baseline cohort of stage IV pts, 76.1% received full NGS testing whereas among the post-baseline cohort 89.9% received full NGS testing. Conclusions: The QI at AON that focused on biomarker testing among E-Stg resected and stage IV NSCLC pts led to improvements in EGFR testing rates in E-Stg pts, and timing of EGFR test results prior to treatment of stage IV pts, and full NGS testing among stage IV NSCLC pts.