Optimizing Biomarker Detection and Extending Life for Patients with Non-Small Cell Lung Cancer

  • Behavior Change,
  • Clinical Transformation
Project Status: Complete

This project integrated plasma-based next-generation sequencing into clinical pathways to optimize detection of recommended biomarkers. Findings demonstrate behavioral nudges can promote guideline concordant testing in community and academic sites and should be studied further to improve rates of molecular testing in non small-cell lung cancer.

When patients are diagnosed with metastatic, non-squamous non-small cell lung cancer (NSCLC), biomarker testing is crucial to determine the optimal treatment. For example, for the 30% of those patients with metastatic non-squamous (mNSq) NSCLC who have actionable mutations, targeted therapies have been shown to be an optimal therapy by more precisely attacking cancer cells and thus extending life. Though recommended by NCCN guidelines, genomic profiling such as next-generation sequencing (NGS) is not routinely performed, negatively impacting the detection of NCCN-recommended biomarkers.

NGS uses DNA sequencing of biopsies to detect mutations that may be actionable or therapeutically targetable. These biopsies can be tissue-based or liquid biopsy from plasma. While tissue-based NGS has already been implemented at the Hospital of the University of Pennsylvania (HUP), a recent study showed that the addition of plasma NGS nearly doubled the rate of detection of targetable mutation biomarkers. This project fully integrated plasma-based NGS into the clinical pathways at HUP in order to optimize detection of NCCN-recommended biomarkers. This integration included electronic health record based nudges to promote ordering of plasma NGS and additionally deliver email-based clinical decision support emails to notify clinicians of targetable mutations and appropriate therapies.

In this non-randomized prospective clinical trial study across 3 practice sites in a large health system, an EMR-based nudge intervention was associated with a significantly higher number of patients with NSCLC undergoing comprehensive molecular genotyping, both overall and prior to first-line therapy. These findings demonstrate that behavioral nudges can promote guideline concordant diagnostic testing in both community and academic sites and should be studied further as a tool to improve rates of molecular testing in NSCLC. For more information, visit the iNUDGE project page.

National Comprehensive Cancer Network

Project Leads

  • Charu Aggarwal

    MD, MPH

    Associate Director, PC3I & Director, Program in Precision Oncology Innovation, PC3I

  • Melina Marmarelis

    MD, MSCE

    Assistant Professor of Medicine, Hospital of the University of Pennsylvania

Project Team

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