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E. Hamarstrom

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    P1.01 - Advanced NSCLC (ID 757)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P1.01-025 - Biomarker Testing in Advanced NSCLC: A Simulation-Based Assessment of Medical Oncologists (ID 7982)

      09:30 - 16:00  |  Author(s): E. Hamarstrom

      • Abstract

      The past several years have seen a number of changes in standards of care for NSCLC, challenging oncologists to integrate evolving diagnostic paradigms into practice. A study was conducted using simulation-based technology to assess medical oncologists’ current performance in ordering biomarker testing and diagnosing advanced NSCLC.

      A virtual patient simulation (VPS) consisting of 2 patient cases was made available online via a website dedicated to continuous professional development. The VPS platform allowed oncologists to assess the patients and choose from an extensive database of diagnostic possibilities matching the scope and depth of practice. Clinical decisions made by participants in the VPS were analyzed using a sophisticated decision engine, and instantaneous, formative clinical guidance employing the current evidence-base and expert faculty recommendations were provided. After CG, oncologists had a second chance to address errors of omission. Data were collected between 1/29/2016 and 11/29/2016.

      197 oncologists fulfilled the participation criteria for completing the VPS. Assessment of their clinical decisions prior to CG revealed: · In a patient with newly diagnosed advanced NSCLC, 21% of oncologists did not order histopathology to determine subtype while 58% failed to order EGFR mutational testing Moreover, 30% ordered ROS1-translocation FISH testing and 39% PD-L1 IHC testing. Interestingly, although no approved targeted agent exists for MET amplified-, RET-translocated-, or BRAF-mutated NSCLC, 17%-28% ordered these molecular tests. · In a patient with EGFR-mutated NSCLC who had progressed on first line EGFR TKI, 40% did not order testing for T790M. Moreover, 40% ordered PD-L1 staining. Consistent with findings from the first case, between 11%-18% ordered testing for rarer mutations for which patients may qualify for a clinical trial.

      Histopathologic and biomarker testing are critical elements for selecting the most appropriate regimen for patients with advanced NSCLC across the continuum of care. Our analysis of current practice using a VPS platform that immerses and engages the clinician for an authentic, practical and consequence-free experience demonstrates that there is variability in biomarker testing by oncologists. In addition, our findings demonstrate a continued need to educate oncologists about prioritizing biomarker tests in order to select the most appropriate regimen for a patient with advanced NSCLC.