Brief Report on Global Clinician Practices in the First-Line Management of Metastatic Non-Small Cell Lung Cancer.

Introduction: In the dynamic landscape of metastatic NSCLC (mNSCLC) management, marked by several frontline options and the integration of next generation sequencing (NGS) for informed decision-making, barriers persist despite advancements. This includes challenges in clinical trial recruitment. To gain global insights into clinicians' practices, we conducted a survey on their testing and management approaches for patients with mNSCLC.
Methods: The survey, conducted from July 12 to August 20, 2023, utilized multiple-choice questions and qualitative research questions, employing the Likert Scale for comprehensive insights.
Results: A total of 127 individuals responded, with 72% affiliated with academic health systems, and 55% practicing in the USA. Regarding testing practices, 93% consistently ordered NGS for non-squamous histology, while 54% did so for squamous cell histology. Concurrent tissue and liquid biopsies were routinely ordered by 28%, while 39% reported ordering both testing platforms concurrently for select cases only. Respondents cited logistical barriers, such as insufficient tissue and lack of infrastructure, as the most common hindrance to molecular testing (76%), followed by reimbursement challenges (56%) and concerns about delayed turnaround time (50%). While most respondents were confident in interpreting NGS results, 22% lacked confidence. Concerning treatment decisions, 72% preferred awaiting molecular testing results before initiating systemic therapy. Less than 50% routinely referred patients for clinical trials in the frontline setting for mNSCLC. For patients with disease expressing high PD-L1 levels, most oncologists preferred pembrolizumab monotherapy. For disease with low PD-L1 expression, a platinum doublet chemotherapy regimen combined with pembrolizumab was favored. In disease cases with negative PD-L1 expression, a platinum doublet chemotherapy regimen with pembrolizumab was preferred. Key factors influencing oncologists' preferred immune checkpoint inhibitor (ICI) included experience with one ICI over another, preferred status per national guidelines, availability of trial data with a significant follow-up period, and consideration of drug cost.
Conclusion: Although this study demonstrates an improved awareness and adoption of ordering NGS for the management of mNSCLC, it underscores the persistence of various barriers that must be addressed to improve upon the quality of care for patients diagnosed with mNSCLC.
Competing Interests: Disclosure AS: None. HJW: Howard Jack West reports a relationship with Summit Therapeutics plc that includes: employment. Howard Jack West reports a relationship with AbbVie Inc that includes: consulting or advisory. Howard Jack West reports a relationship with Amgen Inc that includes: consulting or advisory. Howard Jack West reports a relationship with Genetech Biotech Co Ltd that includes: consulting or advisory. Howard Jack West reports a relationship with Gilead Sciences Inc that includes: consulting or advisory. Howard Jack West reports a relationship with Merck & Co Inc that includes: consulting or advisory. Howard Jack West reports a relationship with Mirati Therapeutics Inc that includes: consulting or advisory. Howard Jack West reports a relationship with Regeneron Pharmaceuticals Inc that includes: consulting or advisory. Howard Jack West reports a relationship with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees. Howard Jack West reports a relationship with Merck & Co Inc that includes: speaking and lecture fees. EKS: Eric K. Singhi reports a relationship with AstraZeneca Pharmaceuticals LP that includes: consulting or advisory. Eric K. Singhi reports a relationship with Novocure that includes: consulting or advisory. Eric K. Singhi reports a relationship with Amgen Inc that includes: consulting or advisory. Eric K. Singhi reports a relationship with Janssen Pharmaceuticals Inc that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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