The 2024 World Conference on Lung Cancer (WCLC) will be held in San Diego, USA, from September 7-10. Dr. Matthew Smeltzer, Associate Professor , Division of Epidemiology, Biostatistics, and Environmental Health at the University of Memphis, Tennessee, will present the analysis of the “2024 International Association for the Study of Lung Cancer (IASLC) Global Survey on Biomarker Testing” in an oral session titled “OA03 Predicting the Future: New Pathology Assessments and Imaging Biomarkers.”

According to a global survey presented at WCLC 2024, the factors hindering optimal biomarker testing in early and advanced lung cancer patients are similar, including cost, time, tissue sample quality, access pathways, and awareness.

IASLC conducted a biomarker testing survey in the spring of 2024 and compared the results with a similar survey conducted in 2018. The previous survey indicated that the adoption rate of biomarker testing was low due to issues such as cost, lack of quality and standards, access, awareness, and long transport times. Since then, progress has been made in the treatment guidelines for both early and advanced non-small cell lung cancer (NSCLC).

The latest survey revealed that 63.4% of respondents believed biomarker testing was critical for advanced lung cancer, and 29.4% believed it was essential for early-stage lung cancer. Additionally, 98.3% of respondents thought that biomarker testing significantly impacts outcomes, and 91.2% indicated that they clearly understood who should receive biomarker testing.

In a press release discussing the survey, Dr. Matthew Smeltzer remarked, “In 2018, we asked a similar question: Do you think more than half of lung cancer patients in your country are being tested? Back then, the response was 39%, and now it has increased to 67%. This is a significant improvement (P < 0.0001), indicating that more lung cancer patients are being tested. However, 43% of patients reported that they often start treatment before receiving biomarker results. This is something we want to avoid, as it highlights a gap in delivering timely results to patients who need prompt treatment decisions.”

The factors most frequently cited as barriers to optimal biomarker testing were cost (27.2%), time (13.9%), tissue sample quality (13.8%), access (12.8%), and awareness (8.0%). Data analysis from the survey team indicated that cost is a multifaceted issue, varying by country. When asked about reimbursement policies for biomarker testing in their institutions or healthcare systems, 25% of respondents said all biomarker testing is fully reimbursed, 37% reported partial reimbursement based on specific standards or guidelines, 18% said reimbursement is limited or comprehensive testing is challenging, and 13% noted no reimbursement policy for biomarker testing.

In his presentation, Smeltzer noted, “Cost is a universal concern, and it’s a multifactorial issue. We need to continue addressing it. The inefficiency of patient testing is a problem we can’t fully pinpoint, but the system as a whole can work more effectively.”

When asked which potential solutions could help reduce the cost of biomarker testing in their respective countries, 63% of respondents suggested demonstrating the cost-effectiveness of biomarker testing to decision-makers, 55% recommended working with policymakers to mandate or encourage full reimbursement, 49% supported negotiating new cost-sharing agreements with diagnostic companies, 41% suggested working with payers to establish cost-sharing agreements, and 39% advocated for increasing patient financial support programs.

During the press release, Smeltzer added, “Although this is a complex issue that varies by region, some factors are universally shared. Some aspects depend on where you work or live, but overall, it seems we still need to better communicate the value of biomarker testing and why it’s important.”

Regarding time barriers, the median turnaround time for tissue testing was 14 working days. However, when asked which steps in the process would most improve the turnaround time for biomarker testing, respondents did not reach a consensus on a single source of delay. Nearly 700 respondents indicated that the time from tissue sample processing to molecular analysis was the step most likely to benefit from improvement, thereby reducing the overall turnaround time.

Pathology reports indicated that small tissue sample sizes were the leading cause (48%) of why biomarker testing was not performed in patients with advanced-stage cancer, making tissue sample quality another significant barrier. Insufficient tumor cell quantities were more common in patients diagnosed with unresectable, locally advanced, or metastatic lung cancer, which limited the success of biomarker testing. The same issue was cited by early-stage, operable lung cancer patients, who often requested repeat tissue biopsies for similar reasons.

“This indicates a potential problem. When biopsy material is insufficient, we are essentially unable to test the samples we receive,” Smeltzer explained. “We asked why this occurs, and those responsible for obtaining tissue samples said the most common reason was an insufficient number of tumor cells in the biopsy, followed by poor tissue quality.”

As a potential solution, Smeltzer suggested that when tissue biopsy quality is poor, other tools like liquid biopsy could be helpful. “When tissue samples are unavailable, liquid biopsy is another tool we can utilize. I think it’s essential to develop any tool that helps us better understand the disease, and we need to remain open to new technologies and how we can rigorously advance them,” Smeltzer said.

The final barrier identified was awareness. While 54% of respondents stated that their institutions used CAP-IASLC-AMP biomarker testing guidelines, 21% used other guidelines, and 26% were unaware of any guidelines. Additionally, 68% of respondents said that educating patients about biomarker testing after a lung cancer diagnosis was very necessary, 29% thought it was somewhat necessary, and 3% believed it was unnecessary.

A total of 1,677 evaluable responses were received from 90 countries and 14 disciplines, including medical oncologists, pathologists, thoracic surgeons, pulmonologists, and others.

Smeltzer concluded, “One important takeaway is that we’ve seen a shift in the perception of biomarker testing. While it may still fall short for some patients, it is indeed a necessity for every lung cancer patient.”