ASCO 2025 | Disparities in biomarker-targeted therapy for resected NSCLC

Another study we did, we did in conjunction with colleagues at AstraZeneca, we looked at the Flatiron database, which is a unique dataset that was put together, aggregating material from predominantly non-academic healthcare systems around the United States. And what we were interested in looking at was among people who have had surgery for lung cancer who qualify for adjuvant therapy, what the rate of biomarker testing was and in a second step, how often the appropriate adjuvant therapy was administered to people with specific biomarker profiles. The reason for that, of course, is we know that patients who have had surgery for lung cancer continue to have a high rate of disease recurrence and death, and we know that adjuvant therapy significantly reduces that risk. We also know in sequential studies that patients who have certain types of lung cancer, such as EGFR-mutated lung cancer benefit from specific targeted adjuvant therapies, and patients who don’t have specific gene mutations benefit from immunotherapy. So the first piece of news is kind of good. We found that approximately 80% of this Flatiron cohort actually had had a biomarker test, which was a pleasant surprise because our past understanding has been that biomarker testing rates are much much lower than that so this is the first time we have seen such high rates now we don’t fully understand why we found such a result in this but we’ll take it if it’s true but digging a little bit into it you find that there are some differences in that subset so the testing for ALK for example, is in the 60% range. The testing for EGFR is slightly higher than that, and the testing for PD-L1, the marker for immunotherapy, is a bit higher than that. But the interesting things we did find still, though, were that not everybody has equal opportunity to get tested. So people with stage 1b for example tended to have the lowest testing rates patients who were black were less likely to get tested now when we looked at the use of guideline-recommended adjuvant therapy we found very striking that patients who received the guideline-recommended adjuvant therapy had much better survival than patients who did not and the other thing we found was that when we looked within the group that had guideline-concordant treatment there was no difference in survival between all the subsets suddenly the disparity that you see that you expect to find gone. So the lesson there is that A, we do need to ensure that everybody gets this biomarker test and B, just as important, we need to ensure that the next step is taken, which is to link treatment appropriate, guideline-appropriate treatment with the test results. And if we do that, it looks like we’re going to be able to raise the survival level across the board in our populations.

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