Evolving genetic testing and treatment pathways in non-small cell lung carcinoma: a Healthcare Professional survey of current practices in the UK

Abstract

The treatment of non-small cell lung carcinoma (NSCLC) has changed significantly in recent years with the discovery of new oncogenic mutations and the introduction of immunotherapy. In March-June 2021 we conducted 57 interviews with healthcare professionals (HCPs) involved in the secondary care management of patients with NSCLC (39 oncologists, 10 nurses, 5 pathologists, 3 respiratory physicians) representing geographically dispersed NHS Trusts across the UK. The aim was to understand the current UK NSCLC patient pathway in relation to oncogenic mutation testing practices, treatment preferences as well as anticipated future trends. In terms of genetic testing, a variety of tests were commonly performed although the testing location varied. 47% (n=27) of respondents represented hospitals that performed genetic testing onsite, 30% (n=17) offsite, and 23% (n=13) at a genomic laboratory hub. Genetic tests perceived to be clinically relevant despite not currently being accessible or reimbursed included MET and HER-2 (Fig. 1). In terms of treatment preferences, in an adjuvant setting, respondents (n=46) estimated a median of 20.0% (IQR 10.0%-30.0%) of eligible patients decline chemotherapy despite being fit enough to receive it. Declining treatment in metastatic NSCLC was estimated to be 17.5% (10.0%-30.0%; n=46) for second/third line treatment. The most common reason for declining treatment was perception on impact on quality of life (89%, n=50/56). The survey highlights variance in mutation testing practices across the UK, which may impact diagnosis and treatment decisions, and in turn may contribute to health outcome inequalities. Molecular driven treatments tend to be better tolerated; as biomarker testing expands and targeted options become available, more patients may be willing to accept treatment. Insights suggest that future areas of clinical interest in NSCLC are MET, HER-2, KRAS and personalised neo/ adjuvant therapies. The survey results conclude there are a number of areas of unmet need remaining within the NSCLC patient pathway.