Spotlight audit on molecular testing in advanced lung cancer 2019 (for diagnoses in 2017)

Executive summary

The discovery of driver gene mutations in patients with lung cancer has led to significant advances in the treatment options available for these patients. The current standard of care is for all patients with advanced lung adenocarcinoma (and other non-squamous subtypes) to have molecular testing at diagnosis for at least epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) and ROS-1 rearrangements, as well as assessment of expression of programmed death ligand 1 (PD-L1) on neoplastic cells. Previous real-world studies, however, have consistently demonstrated a gap between results of implementation and standards for molecular testing in this cohort of patients. This spotlight audit is the first national study investigating the efficacy and outcomes of molecular testing in patients with advanced non-small-cell lung cancer (NSCLC) in England.

142 NHS trusts were invited to take part in the study and asked to provide data on at least 15 patients diagnosed with advanced lung cancer between June and December 2017. Of these, 60 trusts took part providing data on 1,157 patients. Key findings included:

1. 83% of patients with advanced adenocarcinoma underwent molecular testing for all three of the recommended predictive biomarkers (EGFR, ALK and PD-L1).
2. 96% of molecular tests were successful in providing adequate results.
3. 11.5% of patients required second biopsies to obtain molecular results. There was an increased likelihood of patients requiring a second sampling technique if the initial attempt was through pleural biopsy or aspiration.
4. The median turnaround time from tissue acquisition to EGFR mutation result was 18 days.
5. First-line targeted therapies were received by 75% of patients following confirmation of an EGFR mutation and 58% of patients with an ALK translocation.