Two abstracts involving real-world data (RWD) presented at the 2021 American Society of Clinical Oncology Quality Care Symposium tracked the uptake of next-generation sequencing (NGS) and biomarker testing by practices in the OneOncology network.
One abstract examined NGS testing patterns for advanced non–small cell lung cancer (NSCLC) and metastatic breast cancer at 4 OneOncology practices that use Flatiron’s OncoEMR electronic health record. The second looked at biomarker testing in advanced NSCLC at 4 sites. The abstracts were presented September 25 by authors from OneOncology and Genentech, a member of the Roche Group, which acquired Flatiron Health in 2018.
"Biomarker and next-generation sequencing are the backbone of personalized treatments in oncology," Lee Schwartzberg, MD, OneOncology’s chief medical officer and senior author on both abstracts, said in a statement. "Understanding current testing patterns and strategies to increase their uptake is a vital component to bring precision medicine to oncology practices across the country. These research presentations identify an important baseline for how the physicians on the OneOncology platform are bringing advanced diagnostics to their clinic and how we can improve future utilization."
Uptake of NGS. Data from the 4 OneOncology sites were collected from January 2015 to May 2020 and compared with de-identified patient data in the Flatiron national database. According to investigators, across the OneOncology sites, 2045 of 3221 patients with advanced NSCLC (63%) received NGS with or without other genetic profile testing compared with 13,681 of 29,572 (46%) in the Flatiron NSCLC database. In metastatic breast cancer (mBC), 513 of 1295 (40%) got NGS at the OneOncology sites compared with 2458 of 12,175 (20%) in the Flatiron database.1
Data showed the dramatic uptake of NGS across the 5-year period, both at OneOncology and nationwide; NGS was used in 41% of the patients with NSCLC diagnosed at the 4 sites in 2015 compared with 72% by 2020; NGS was used in 22% of cases in the national database in 2015 and 60% by 2020. The gap between OneOncology and the national databased was wider in mBC: Uptake of NGS shifted from 42% to 53% over the study period at OneOncology and 17% to 27% across the database. Testing rates were highest for patients with BRCA and HER2. In advanced NSCLC, the median time from diagnosis to NGS testing in OneOncology was 33 days vs 32 days for the Flatiron database; for mBC, it was 70 days for OneOncology vs 188 days in the database. The study authors observed that patients in the OneOncology sites were slightly younger and slightly more likely to have commercial insurance than those in the national database.
Biomarker testing. RWD were analyzed to show a similar uptake in testing for specific biomarkers over time; the statement from OneOncology noted that the network implemented a precision medicine initiative in 2019, but data show increased use before that time. Biomarkers evaluated were ALK, BRAF, EGFR, ROS-1, and KRAS.2
Testing rates for all 5 biomarkers were higher in advanced NSCLC with NGS than with other tests for OneOncology (87% vs 6%) and in the Flatiron national database (87% vs 11%). In mBC, a higher rate of BRCA was seen with NGS than with other tests in OneOncology (68% vs 26%) and in the national database (71% vs 28%); similar rates were seen for HER2 (98% across both types of tests in OneOncology and 100% vs 99% in the Flatiron database).
A similar pattern of increased testing for biomarkers was seen over time: Patients who received all 6 biomarker tests increased from 13% in 2015 to 57% in 2020. Among the tested patients, the median time from advanced diagnosis to the first test result was 20 days. According to the statement from OneOncology, the time from specimen collection after advanced diagnosis to the first test result was 13 days.
“Of 1207 patients with a NSCLC with actionable mutations, 390 (32%) received treatment before receiving their test results,” the statement said.
1. Vanderwalde AM, Ma E, Yu E, et al. NGS testing in advanced non–small cell lung cancer (aNSCLC) and metastatic breast cancer (mBC): OneOncology (OO) sites compared to Flatiron Health Nationwide (NAT). Presented at: ASCO 2021 Quality in Care Symposium; September 24-25, 2021. Abstract 288. doi:10.1200/JCO.2020.39.28_suppl.288
2. Vanderwalde AM, Ma E, Yu E, et al. Biomarker testing patterns and actionability in advanced non-small cell lung cancer (aNSCLC) at OneOncology (OneOnc). Presented at: ASCO 2021 Quality in Care Symposium, September 24-25, 2021. Abstract 287. https://ascopubs.org/doi/abs/10.1200/JCO.2020.39.28_suppl.287