• A recent survey has found that only 48 percent of community oncologists use biomarker testing in treating people living with lung cancer, compared to 73 percent of academic oncologists.
• Biomarker testing can help doctors determine the best targeted therapies for people’s specific cases of lung cancer.
• The survey highlights the need for improving education on biomarker testing and making resources available to get people the treatment they need.

Less than half of community oncologists use biomarker testing in determining lung cancer treatments, compared to 73 percent of oncologists in academic medical settings, according to a recent survey. Biomarker testing can help doctors decide which treatments are best for specific cases of lung cancer. The findings suggest people from underserved populations living with the condition may not receive the best possible treatments.

“Recent advances in cancer genomics and targeted therapies have substantially changed the management of lung cancer,” according to an International Association for the Study of Lung Cancer (IASLC) press release, “but like many new medical technologies, there is a concern these new methods, which include biomarker testing, will not be used equally throughout the health care system and worsen disparities that may already be entrenched.”

Biomarker Testing Can Guide Lung Cancer Treatment

Recent advancement in genetic testing allows oncologists to sequence the DNA of tumors to find out what genes are mutated in the cancer. Called biomarker testing, this technique is especially important in treating cases of non-small cell lung cancer (NSCLC). In 2013, several medical groups came together to develop a set of guidelines for biomarker testing in lung cancer. They updated the guidelines in 2018, which specify “must-test” and “should-test” biomarkers for people with lung cancers.

Doctors test for two main types of biomarkers to help them decide on treatment plans for NSCLC: driver mutations and expression of the protein PD-L1. Driver mutations are genetic mutations found in tumor cells that tell them to quickly grow and divide. The protein PD-L1 is used to determine if a person would respond well to immunotherapy drugs; higher levels of PD-L1 means a person may respond better.

Many therapies used to treat NSCLC are aimed at specific mutations. Called targeted therapies, they work well in people whose tumors have driver mutations that are responsible for causing cells to quickly grow and divide. Biomarker testing is important in helping doctors decide who should be placed on these treatments and who would not benefit from them.

Community Oncologists Use Biomarker Testing Less Than Academic Oncologists

Researchers from the Association of Community Cancer Centers (ACCC) surveyed oncologists who treat people with NSCLC who were either covered by Medicaid or uninsured. The main goals of the survey were to look at attitudes and practice patterns surrounding biomarker testing.

Although the biomarker testing guidelines were released in 2013 and updated in 2018 as a resource for oncologists, only 40 percent of the 99 survey respondents said they were “very” or “extremely” familiar with them. Notably, only 48 percent of oncologists who practice at community clinics use biomarker testing, compared to 73 percent of oncologists who practice in academic settings, the survey found.

The surveyed oncologists said barriers to biomarker testing include limited education, financial resources, and understanding of the guidelines.

A Hope for Greater Testing Access

The survey findings, presented at the IASLC 2021 World Conference on Lung Cancer in September, show a need for better education and familiarity with biomarker testing among community oncologists. “Our study identifies key areas of ongoing clinician need related to biomarker testing, including increased guideline familiarity, practical applications of guideline-concordant testing and how to optimally help coordinate multidisciplinary care,” said study lead Dr. Leigh Boehmer, chief medical officer of the ACCC, in an interview with Healio.

The researchers hope these findings will help improve the availability of testing and more people will get the treatment they need.