Impact of Reflex EGFR/ALK Testing on Time to Treatment of Patients With Advanced Nonsquamous NSCLC
Working from the premise that patients with NSCLC who initially receive targeted agents that match the oncogenic drivers of their disease have improved survival, these investigators set out to determine whether reflex testing by pathologists at the time of diagnosis of nonsquamous NSCLC, regardless of stage, would improve time to treatment. According to the authors, who performed a retrospective review of patients from a Canadian cancer center, “Major barriers to implementing personalized medicine have been identified as having to wait for biomarker results with the risk of clinical deterioration of a patient and the difficulty of obtaining sufficient tissue for molecular testing.”
Of note, the study highlighted the importance of an expert and skilled multidisciplinary team and underscored the pathologist’s role. “Pathologists requesting biomarkers at the time of diagnosis of nonsquamous NSCLC are in the best position to optimize the use of available tumor material,” the authors observed.
Results showed that reflex testing was associated with a significant improvement in time to treatment for patients who were suitable for systemic therapy and in time to initiating optimal systemic therapy.
Noting that the benefit of reflex testing must be balanced against the extra cost incurred by EGFR and ALK testing for patients with early-stage disease who do not experience a relapse, the investigators pointed out: “Unfortunately, this applies to a minority of patients because the 5-year survival rate across all stages is 18%, with a significant number of patients progressing to advanced disease.”
In conclusion, reflex testing may reduce barriers and facilitate the implementation of personalized medicine for patients with advanced NSCLC by improving the quality of testing and the time to optimal systemic therapy.