Optimizing Biomarker Detection and Extending Life for Patients with 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 will fully integrate plasma-based NGS into the clinical pathways at HUP in order to optimize detection of NCCN-recommended biomarkers. This integration will include 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.
Results from the clinical pathways integration at HUP inform a scalable model that can be disseminated to other practices, improving the delivery of cancer care and extending life for patients not only at academic centers like HUP but also at community cancer care programs where the majority of lung cancer patients are treated.
Charu Aggarwal, MD, MPH; Erica L. Carpenter, MBA, PhD; Abigail T. Berman, MD, MSCE; Michael Costello, MD; Peter Gabriel, MD; John Kosteva, MD; Corey J. Langer, MD; Melina Marmarelis, MD, MSCE; David Roth, MD, PhD; Lawrence Shulman, MD
National Comprehensive Cancer Network