A study found that there is a significant difference in the use and treatment of biomarker testing for non-small cell lung cancer

A biomarker test examines specific disease-related molecules to predict treatment response and disease progression; but its use has made it difficult to detect non-small cell lung cancer (NSCLC). In a new study in The Journal of Molecular Diagnosis, published by Elsevier, investigators provide for the first time a complete overview of a biomarker test, spanning multiple treatment lines, in a single group of patients.

Using exploratory data analysis and process mining techniques in a real-world situation, researchers identified a significant difference in test use and handling. They also found that while whole genome sequences, in which a patient’s specific DNA is mapped at the same time, may not be a cost-saving alternative to a biomarker test, as some have suggested, There may be other benefits for patients, such as reducing the time between testing and treatment.

“While there is much interest in using real-world data to examine differences in treatment and outcomes, this study highlights the importance of identifying differences in treatment. the use of molecular experiments as a gateway to most cancer treatments, “explains lead researcher Professor Maarten IJzerman, Health Technology and Services Research, TechMed Center, University of Twente, Enschede, The Netherlands; and University of Melbourne Cancer Research Center in Melbourne, Australia.

The investigators had access to a total biomarker test history of 102 stage IV NSCLC patients sent to a complete cancer center in the Netherlands. Patients are referred to such a facility when they have a complex case, enroll in a clinical trial, or have spent treatment options at the referral hospital. Eligible patients were identified using linked pathology data from the referral hospitals to ensure that their overall diagnostic pathways were analyzed. Process mining allows the detection of the actual ordering of care processes and for the evaluation of test features, such as turnaround times and costs.

This study is the first to provide a comprehensive report that includes test genes, methods used, costs, and turnaround times on the full suite of tests received by patients with NSCLC stage IV .

Ninety-nine specific biomarker-test combinations were detected in 102 patients; almost none of them underwent the same tests in the same order. The most common biomarkers were usually tested in the first few tests, and emerging biomarkers were usually tested later. There was a significant difference in the number of tests for each patient. Tests were completed at different times in each patient, and in the majority of patients more than one trial was completed.

The average cost per patient of a U.S. biomarker test was $ 2258.52 / € 1881.23. The number of patients for whom biomarker tests would be equally or if the whole test series replaced a whole genome set ranged from 2 to 29, depending on the cost determined.

We have shown that at present it is unlikely that cost savings will replace the current use of molecular testing in lung cancer. However, for the normal use of genome sequences there are other aspects where it adds value, such as the detection of mutations of other drivers that are not routinely tested and the ability to flow- streamline diagnostic work. “

Michiel van de Ven, First Author, PhD Candidate, TechMed Center, University of Twente, Enschede, The Netherlands

Multiple biomarker tests for NSCLC can lead to unnecessary delays in treatment. The large variation of biomarker tests in patients suggests the potential for inequality in access to the tests and subsequently in access to targeted therapy or immunotherapy. “Whole-genome silencing may reduce the complexity of the diagnostic pathway, but it has not yet been studied in detail. It could be an interesting pathway for future research,” says Dr. IJzerman ending.