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A. Shewade
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.01-031 - Utilization and Timing of Foundation Medicine (FMI) Testing in U.S. Advanced Non-Small Cell Lung Cancer (aNSCLC) Patients (ID 8529)
09:30 - 16:00 | Author(s): A. Shewade
- Abstract
Background:
Actionable insights generated by FMI’s hybrid capture-based next-generation sequencing (NGS) comprehensive genomic profiling services are increasingly important for navigating cancer care in aNSCLC patients. FMI and other NGS platforms support treatment decisions by detecting a variety of genetic alterations implicated in oncogenesis. We describe: 1) the characteristics of aNSCLC patients receiving FMI testing and 2) the utilization patterns and timing of FMI testing in relation to treatment and other molecular tests using a real world oncology electronic health record (EHR) database.
Method:
Flatiron Health has a longitudinal, demographically and geographically diverse database containing EHR data, reflecting routine clinical practice, from over 265 cancer clinics in the US. Inclusion criteria were aNSCLC diagnosis and ≥2 clinic visits within the Flatiron network on or after January 1, 2011. Data pertaining to molecular testing was available on 5 biomarkers (EGFR, ALK, KRAS, ROS1, PDL1) and used to identify 3 mutually exclusive testing groups: FMI, other NGS and non-NGS.
Result:
As of March 31, 2017, the aNSCLC cohort included 33,473 patients. Of 1,395 patients with FMI testing, 738 (53%) also had ≥1 non-FMI test (43% EGFR, 40% ALK, 20% ROS1, 17% PDL1, 16% KRAS). In FMI-tested patients, 45% received results before starting a first line of therapy (vs. 57% of other NGS tested and 79% of non-NGS tested patients). Table 1 details patient and testing characteristics for FMI tested patients, along with first treatments received after FMI testing.Table 1. Patient, Testing and Treatment Characteristics for Patients Receiving FMI testing FMI Other NGS Non-NGS No tests Patient count (%) (Total N=33,473) 1,395 (4%) 1,946 (6%) 17,002 (51%) 13,128 (39%) Patient and Testing characteristics Age at aNSCLC diagnosis (years) (median, [IQR]) 67 [59, 73] 68 [60, 75] 69 [61, 76] No history of smoking 335 (24%) 376 (19%) 2,731 (16%) Squamous cell histology 194 (14%) 195 (10%) 1,532 (9%) No. of tests 1 1,224 (88%) 1,587 (82%) n/a ≥2 171 (12%) 359 (18%) Year of testing[a] <2011 0 (0%) 1 (0%) 137 (1%) 2011 0 (0%) 5 (0%) 1,215 (7%) 2012 2 (0%) 16 (1%) 2,368 (14%) 2013 59 (4%) 117 (6%) 2,894 (17%) 2014 185 (13%) 235 (12%) 3,263 (19%) 2015 377 (27%) 560 (29%) 3,099 (18%) 2016 634 (45%) 818 (42%) 2,921 (17%) 2017 (through March 31, 2017) 123 (9%) 186 (10%) 670 (4%) Number and Timing of Other Tests in patients with an FMI test FMI tested prior to start of 1st LoT FMI tested during 1st and before start of 2nd LoT FMI tested during 2nd and before start 3[rd] LoT FMI tested during or after 3rd LoT Patient count (%) (Total N=1,386)[b] 626 (45%) 489 (35%) 157 (11%) 114 (8%) Other tests conducted before FMI testing[c,d] ALK 111 (18%) 188 (38%) 100 (64%) 86 (75%) EGFR 133 (21%) 204 (42%) 110 (70%) 86 (75%) KRAS 51 (8%) 60 (12%) 25 (16%) 29 (25%) PDL1 41 (7%) 44 (9%) 23 (15%) 22 (19%) ROS1 53 (9%) 92 (19%) 40 (26%) 32 (28%) Other tests conducted after FMI testing[c,d] ALK 48 (8%) 34 (7%) 8 (5%) 3 (3%) EGFR 53 (9%) 38 (8%) 9 (6%) 5 (4%) KRAS 35 (6%) 30 (6%) 7 (5%) 2 (2%) PDL1 49 (8%) 33 (7%) 7 (5%) 3 (3%) ROS1 37 (6%) 28 (6%) 6 (4%) 1 (1%) First Treatment immediately following FMI testing Patient count (%) (Total N=802)[e] 424 (68%) 252 (52%) 77 (49%) 49 (43%) NCCN-recommended targeted treatment for aNSCLC (N=196)[f,i] 105 (25%) 56 (22%) 20 (26%) 15 (31%) NCCN-recommended immunotherapy (N=227)[g,i] 82 (19%) 110 (44%) 22 (29%) 13 (27%) Non NCCN-recommended targeted treatment for aNSCLC (N=13)[h,i] 1 (0%) 7 (3%) 1 (1%) 4 (8%) [a] If a patient had more than 1 FMI test, the year of the first FMI test is shown; similarly if a patient had more than 1 other NGS (ie. non-FMI), the first test is shown. If an FMI tested patient had both an FMI and non-FMI NGS test, the year of the first FMI test is shown; similarly if a other NGS tested patient has both an other NGS and non-NGS test, the year of the first other NGS test is shown. [b] 9 patients where the date of FMI test (ie. test result date or sample collection date) in relation to dates of treatment and line of therapy were missing or unknown are not included in this table. [c] Total of 738 patients (53% of all FMI tested patients) also received a non-FMI test in addition to their FMI test. [d] Percentages may not add up to 100% because of patients received more than one test. [e] Based on 802 total patients who received FMI testing and where treatment data was reported following their FMI test. [f ]NCCN-recommended targeted treatments received included the following: erlotinib (N=63), gefitinib (N=10), afatinib (N=56), crizotinib (N=36), ceritinib (N=4), alectinib (N=8), trastuzumab (N=1), vemurafenib (N=2), dabrafenib (N=2), osimertinib (N=19), cabozantinib (N=0); it may be possible for patients to receive regimens containing more than 1 NCCN-recommended targeted treatment. [g] NCCN-recommended immunotherapy (immune checkpoint inhibitors) received included the following: nivolumab (N=189), pembrolizumab (N=29), atezolizumab (N=9); it may be possible for patients to receive regimens containing more than 1 NCCN-recommended immunotherapy. In addition, 2 patients received ipilimumab, an immune checkpoint inhibitor currently not recommended by NCCN for aNSCLC. [h] Non NCCN-recommended targeted treatments received included the following: olaparib (N=2), necitumumab (N=2), cetuximab (N=2), palbociclib (N=1), pazopanib (N=1), temsirolimus (N=1), trametinib (with no dabrafenib) (N=4) ; it may be possible for patients to receive regimens containing more than 1 non NCCN-recommended targeted treatment. [i] Based on the National Comprehensive Cancer Network (NCCN) guidelines for NSCLC, version 6.2017 LoT: line of therapy as recorded in the Flatiron data, IQR: inter-quartile range. Patients with missing data are excluded from the table; Percentages are rounded to closest decimals.
Conclusion:
Patients with FMI testing tended to be younger, non-smokers, and have squamous histology compared to patients receiving non-FMI tests. Nearly 50% of all FMI testing occurred prior to first treatment. Patients receiving FMI testing earlier were less likely to have a non-FMI biomarker test beforehand. Regardless of when FMI testing occurred, ~20-30% of patients received a NCCN-recommended targeted therapy immediately after the FMI test.
