EMBER-Lung: Electronic medical record boosting molecular testing in early stage NSCLC.

Abstract

8075 Background: Actionable alterations are identified in 30-40% of patients with advanced non-squamous (NSq) non-small cell lung cancer (NSCLC). Although previous efforts focused on testing for actionable alterations in the metastatic setting, the emergence of adjuvant targeted therapies and perioperative chemoimmunotherapy has made it imperative to perform molecular testing in the early stage setting as well. We present a prospective clinical trial evaluating an electronic medical record (EMR)-based nudge intervention to promote timely completion of molecular testing in patients (pts) with early stage NSq NSCLC. Methods: The EMBER-Lung trial prospectively enrolled pts undergoing surgical resection in the University of Pennsylvania Health System. The intervention included an EMR-based nudge at the time of the 1 st post-operative visit prompting the clinician to accept an order for comprehensive molecular testing based on NCCN guidelines. A reflex alert detailing therapeutic options was sent to the pt’s care team provided that the pt had at least one actionable alteration detected and tissue was consistent with NSq NSCLC. The primary endpoint was the proportion of pts who underwent comprehensive molecular testing in the pre and post intervention cohorts. Secondary outcomes included the delivery of appropriate adjuvant targeted therapy if a targetable alteration was detected. Clinical characteristics of the pre- and post-intervention cohorts were compared using the Chi-square test or Z score. Results: Between July 2021 and November 2023, 460 pts were included: 243 pts in the post-, and 217 pts in the pre-intervention cohorts. Median age was 68.4 years, 64.3% female; 74.1% were former or current smokers, and mostly stage I (I/II/III; 75.9%, 14.1%, 10.0%, respectively). Pt demographics, smoking, tumor stage, and histology were similar in the pre- and post-intervention cohorts. The proportion of pts with any molecular testing improved after the intervention (101/217, 46.5% vs 208/243, 85.6%, p<0.00001). Moreover, the proportion of pts whose molecular testing was comprehensive also increased post-intervention (80/217, 36.9% vs 197/243, 81.1%, p<0.00001); and this increase was observed across all stages (I-III). A greater proportion of pts with classical EGFR mutations were detected in the post-intervention setting (14/217, 6.5% vs 41/243, 16.9%, p<0.001). No ALK fusions were detected in the pre-intervention cohort, while 5/243 (2.1%) were detected in the post-intervention cohort. Of note, a higher proportion of KRAS G12C mutations were also found post intervention (12/217, 5.5%, vs 33/243, 13.6%, p<0.01). Conclusions: An EMR-based nudge intervention during the post-operative visit after resection of early stage NSCLC improved the proportion of patients with molecular testing. The intervention was feasible, and future research will incorporate this strategy earlier to inform neoadjuvant therapy.