Real-world costs and outcomes associated with biomarker testing by comprehensive genomic profiling (CGP) and non-CGP approaches among patients with metastatic non-small cell lung cancer (mNSCLC).

e20598 Background: Guideline-recommended molecular testing is essential for identifying appropriate targeted therapies (Rx) for treatment of mNSCLC patients (pts). Biomarker testing can be performed by single gene tests, small NGS panels (e.g., 50 gene panel), non-CGP (5-50 gene panels or single gene testing), or no testing. Differences in receipt of targeted Rx, overall survival (OS), and total overall per patient per month (PPPM) costs during LOT1 were examined with multivariable regression analyses. Results: 9,945 mNSCLC pts (1,970 COM, 7,975 MA) were identified: 5,484 with no testing, 2,215 with CGP, and 2,246 with non-CGP testing prior to LOT1. Biomarker testing rates prior to LOT1 were low (45%) but increased during the study period from 42% to 48% (p <0.01). Testing rates were higher for the COM vs MA population (49% vs 44%, p <0.01). A higher percent of pts with CGP received targeted Rx compared to the non-CGP and no testing group (17% vs 11% and 5% respectively, p< 0.01); after adjustment, CGP pts were still more likely to receive targeted Rx. Compared to the no testing group, OS was more favorable for the CGP HR 0.8, 95% CI 0.8-0.9 and non-CGP HR 0.9, 95% CI 0.8-0.9 groups. There was no significant difference in PPPM costs between tested groups: CGP CR 1.2, 95%CI 1.1-1.2 vs non-CGP CR 1.1, 95%CI 1.1-1.2. Conclusions: Rates of biomarker testing among mNSCLC pts are far from optimal despite well-established guideline recommendations and insurance coverage for testing. There was evidence of improved intermediate outcomes (receipt of targeted Rx) with CGP compared to non-CGP or no testing. In addition, OS was improved for tested pts compared to untested. Interventions to help improve biomarker testing are needed. Given the potential benefits of CGP testing (including assessment of biomarkers that cannot be evaluated using small panels), increasing CGP testing may improve outcomes.