RESUMO
BACKGROUND: Biomarker-directed therapy requires biomarker testing. We assessed the patterns of Epidermal Growth Factor Receptor (EGFR) and Programmed Death-Ligand 1 (PDL1) testing in a non-small cell lung cancer (NSCLC) resection cohort. We hypothesized that testing would increase but be unevenly distributed across patient-, provider- and institution-level demographics. METHODS: We examined the population-based Mid-south Quality of Surgical Resection (MS-QSR) cohort of NSCLC resections. We evaluated the proportions receiving EGFR and PDL1 testing before and after approval of biomarker-directed adjuvant therapy (2018-2020 versus 2021-2022). We used association tests and logistic regression to compare factors. RESULTS: From 2018-2022, 1687 patients had NSCLC resection across 12 MS-QSR institutions: 1045 (62%) from 2018-2020; and 642 (38%) from 2021-2022. From 2018-2020 11% had EGFR testing, versus 38% in 2021-2022 (56% in those meeting ADAURA trial inclusion criteria, p<0.0001). From 2018-2020, 8% had PDL1 testing, versus 20% in 2021-2022 (p<0.0001). EGFR testing did not significantly differ by age (p=0.07), sex (p=0.99), race (p=0.33), or smoking history (p=0.28); PDL1 testing did not differ significantly by age (p=0.47), sex (p=0.41), race (p=0.51), or health insurance (p=0.07). Testing was significantly less likely in non-teaching and non-Commission on Cancer-accredited hospitals and after resection by cardiothoracic or general surgeons (versus dedicated thoracic surgeons) (all p<0.05). CONCLUSIONS: EGFR and PDL1 testing increased after approval of biomarker-directed adjuvant therapies. However, testing rates were still suboptimal and differed by institutional and provider-level factors. IMPACT: The association of institutional, pathologist, and surgeon characteristics with differences in testing demonstrate the need for more standardization in testing processes.
