Aim: To understand physicians' attitudes and behaviors regarding EGFR testing and retesting strategies in newly diagnosed metastatic non-small cell lung cancer patients.Materials & methods: Oncologists and pathologists completed an online, cross-sectional survey.Results: Most oncologists (73.3%) and pathologists (53.4%) agreed that concurrent testing increases sensitivity for detecting EGFR mutations. Upon tissue insufficiency, oncologists and pathologists reported using liquid biopsy 77.0% and 39.0% of the time, respectively. Tumor accessibility, smoking status, patient willingness and age were key drivers of tissue re-biopsy. Most oncologists reported high confidence in proceeding to first-line therapy based solely on liquid biopsy (60.7-80.0%); fewer pathologists (37.9%) were comfortable with this decision.Conclusion: Variation in physicians' perceptions of testing and retesting highlights the need for greater stakeholder consensus.
Keywords: EGFR testing; biomarker testing strategies; genomic alteration; liquid biopsy; metastatic non-small cell lung cancer; perceptions; preferences; tumor tissue re-biopsy.
Treatment for non-small cell lung cancer that has spread to other organs is based on a patient’s specific subtype of cancer (mutational status), which is found out through biomarker testing. The standard biomarker testing method is to take a sample of the cancer through biopsy or surgery (tumor tissue testing). However, liquid biopsy (LB), a blood test to look for signs of the cancer in the bloodstream, is becoming more common when tumor tissue is not on hand or not able to get. This study hoped to learn about different doctors’ views on blood tests and find out what elements affect biomarker testing and re-testing choices. Most oncologists (doctors who treat cancer) and pathologists agreed that doing both a tumor tissue test and blood test together raises the likelihood of finding a mutation that can help guide treatment choices. When a tumor tissue test was unsuccessful, the most important elements that decided whether to retry was ease of getting to the tumor, smoking status, patient willingness and age. Oncologists were more confident making treatment choices based only on a LB when compared with pathologists. Our study showed notable variation in choices, thoughts, attitudes and behaviors associated with testing and retesting strategies, as well as inconsistent practice patterns and a potential lack of following guidelines. Greater agreement on the role of LB is needed, as well as efforts to deal with barriers to treatment and inconsistent care, which will result in fairer and better care for patients.