Biomarker testing in early-stage NSCLC: Results from the MYLUNG Consortium.

8047 Background: The Molecularly Informed Lung Cancer Treatment in a Community Cancer Network: A Pragmatic Consortium (MYLUNG) program seeks to identify and resolve barriers to biomarker testing in patients (pts) with non-small-cell lung cancer (NSCLC). We previously reported prospectively collected molecular testing data in pts with Stage IB-IV NSCLC (Evangelist et al. 2023). Herein we report additional data on molecular testing rates and patterns in the cohort of pts with early-stage (ES) NSCLC. Methods: Pts were enrolled from 12/20-9/22 at 18 community practices (76 sites) across the US Oncology Network. Analyses performed in the ES cohort include rates of molecular testing for targets with approved (PD-L1 , EGFR) or emerging ( ALK) therapies for ES NSCLC and next-generation sequencing (NGS); reasons for not testing; and treatment (Tx) received, including targeted therapy and immunotherapy (IO). Analyses are preliminary as data collection continues over 5-year follow-up. Results: Included in this analysis were 284 pts with newly diagnosed Stage IB-IIIA NSCLC: median age 68y (range 32, 92); 50% female; 54% ECOG 0-1; 61% adenocarcinoma, 36% squamous cell carcinoma. In total, 76% of pts (82% of pts with adenocarcinoma vs 67% with squamous cell carcinoma) had molecular testing ordered prior to or within 12 weeks of initiating first systemic therapy. Rates of testing (either alone or inclusive of other tests) were PD-L1 ,74%; EGFR,71%; ALK, 62%; EGFR + PD-L1, 61%. In total, 52% of pts had NGS testing; overall, 16% received no molecular testing. The most common reasons for not testing were patient and/or provider attitude/perception (34%) and insufficient tumor tissue (25%). Conclusions: New therapeutic options provide a catalyst to increase molecular testing in ES NSCLC. EGFR and PD-L1 testing are now standard for the management of these pts, with other biomarkers emerging. In this study, 54% of pts received testing for PD-L1, EGFR, and ALK, with additional therapy being offered in pts with biomarker-positive tumors; however, 16% still received no molecular testing at all. For pts with EGFRwt/PD-L1+ tumors, prescription of IO increased 1.8-fold post-adjuvant FDA approval. Data from this and future analyses will be used to implement interventions to improve molecular testing rates in NSCLC. Table: see text