Actionable biomarkers in a non-small cell lung cancer (NSCLC) clinical pathway (CP)


Aurora Health Care


BACKGROUND: Oncologists use Via Pathways (VP) to drive standardization to best evidence-based cancer care. VP include guidance for biomarker testing and associated treatments. Practices collaborated to analyze the first line non squamous carcinoma NSCLC VP. An unexpectedly large percentage of treatment decisions captured by oncologists in the VP portal had unknown ALK translocation or EGFR mutation test results. The VP was modified to require input of whether or not the test was ordered. This analysis examines the impact of this change.

METHODS: ALK and EGFR testing responses from the VP database were analyzed pre and post implementation of the change. Treatment decisions were reviewed to analyze prescribing patterns.

RESULTS: From 1/1/2014 to 1/29/2015, ~40% of EGFR or ALK testing responses were unknown. Post-implementation (1/30/2015 to 5/31/2015), 29.8% were charted as awaiting ALK results and 9.4% did not order the test; 29.5% were charted as awaiting EGFR results and 7.6% did not order the test. For the combined period, appropriate targeted agents were selected for 91.9% (n = 37) and 86.5% (n = 133) of patients who were ALK translocation positive and EGFR sensitizing mutation positive, respectively.

CONCLUSIONS: Results demonstrate the ability of CP to promote testing of key biomarkers and use of appropriate targeted agents. Frequent evaluation and modification of pathway content is needed to ensure practice patterns are accurately captured.

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