Biomarker testing and time to treatment decision in patients with advanced nonsmall-cell lung cancer
Biomarker testing and time to treatment decision in patients with advanced nonsmall-cell lung cancer
复制标题
DOI：
10.1093/annonc/mdv208
复制
发表时间：
2015-07-01
影响因子：
50.5
通讯作者：
Leighl, N. B.
中科院分区：
文献类型：
--
作者：
Lim, C.;Tsao, M. S.;Leighl, N. B.
背景：检测EGFR突变和ALK重排已成为治疗晚期非小细胞肺癌（NSCLC）的标准。然而，欧洲、北美和世界其他地区的许多机构仍然面临着一个共同的挑战，即促进及时的分子检测和快速的结果周转时间。我们评估了晚期NSCLC患者生物标志物检测的流行率以及检测是否影响治疗决策的及时性。研究方法：我们对2010年4月1日至2013年3月31日期间转诊至Margaret癌症中心的四分之一晚期NSCLC患者的随机样本进行了回顾性图表审查。结果：在回顾的300例患者中，175例由内科肿瘤学检查为非鳞状NSCLC，其中72%进行了生物标志物检测。接受生物标志物检测的患者更可能是女性（47%对21%，P = 0.002）、亚洲人（27%对6%，P = 0.005）和从不吸烟者（42%对8%，P < 0.0001）。只有21%的生物标志物检测患者在初次肿瘤咨询时获得了结果。该组从咨询到治疗决定的中位时间较短（0 vs 22天，P = 0.0008），治疗开始时间较短（16 vs 29，P = 0.004）。13%的患者在初次咨询后接受了重复活检进行分子检测。在EGFR或ALK结果阳性的患者中，19%在生物标志物结果可用之前开始化疗。结论：等待生物标志物检测结果可能会延迟晚期NSCLC患者的治疗决定和治疗开始。这可以通过将反射生物标志物检测纳入病理学家水平的NSCLC诊断算法中来避免，并对参与获得诊断癌症标本的专家进行进一步教育，以确保它们足以进行分子检测。
Background: Testing for EGFR mutations and ALK rearrangement has become standard in managing advanced nonsmall- cell lung cancer ( NSCLC). However, many institutions in Europe, North America and other world regions continue to face a common challenge of facilitating timelymolecular testing with rapid result turnaround time. We assessed the prevalence of biomarker testing for advanced NSCLC patients and whether testing affected the timeliness of treatment decisions. Methods: We conducted a retrospective chart review of a random sample of one- quarter of all patients with advanced NSCLC referred to the PrincessMargaret Cancer Centre from 1 April 2010 to 31March 2013. Results: Of 300 patients reviewed, 175 seen by medical oncology had nonsquamous NSCLC, 72% of whom had biomarker testing carried out. Patients tested for biomarkers were more likely to be female ( 47% versus 21%, P = 0.002), Asian ( 27% versus 6%, P = 0.005) and never smokers ( 42% versus 8%, P < 0.0001). Only 21% of patients with biomarker testing had results available at their initial oncology consultation. This group had a shorter median time from consultation to treatment decision (0 versus 22 days, P = 0.0008) and time to treatment start (16 versus 29, P = 0.004). Thirteen percent underwent repeat biopsy for molecular testing after the initial consultation. Of those with positive EGFR or ALK results, 19% started chemotherapy before biomarker results became available. Conclusions: Awaiting biomarker testing results can delay treatment decisions and treatment initiation for patients with advanced NSCLC. This may be avoided by incorporating reflex biomarker testing into diagnostic algorithms for NSCLC at the level of the pathologist, and further education of specialists involved in obtaining diagnostic cancer specimens to ensure they are sufficient formolecular testing.