Results from the 2024 IASLC global biomarker testing survey show that biomarker testing in lung cancer has gone from “nice to have” to a “must have” for clinicians and patients around the world. But a significant gap remains in how clinicians perceive its importance based on disease stage. Nearly two-thirds of clinicians surveyed (63%) ranked biomarker testing as highly important in late-stage disease versus 29.4% in early-stage disease.
“The gap is important,” said Matthew Smeltzer, PhD, Associate Professor of Epidemiology and Biostatistics at the University of Memphis School of Public Health and Deputy Chair of the IASLC Communications Committee. “People still don’t value biomarker testing nearly as much in early-stage disease. We would like everyone to recognize its importance. There have been significant therapeutic advances in both early-stage and late-stage lung cancer in recent years,” Dr. Smeltzer said. “Biomarker testing has become highly relevant to all lung cancer patients. It is probably an awareness issue at this point, which shows there is work to do. We need to get the message out better.”
The 2024 IASLC Global Survey on Biomarker Testing is an update of the IASLC’s first global survey on biomarker testing, which was conducted in 2018. The survey produced 1,677 evaluable responses across 90 countries and 14 disciplines. The greatest numbers of responses came from Asia (585), Europe (454), and North America (357), with fewer responses from South America (123), Oceania (36), and Africa (21).
Knowledge, awareness, and perception of current practice are high and similar across geographic regions and respondents’ role in lung cancer care. Nearly all respondents (98%) said they believe biomarker testing significantly impacts outcomes. Most (91%) had a clear understanding of who should receive testing.
As one respondent said, “Now there are choices that are clearly wrong; drugs that do not work and are inappropriate to give in some situations. If we don’t have the biomarker testing, we could inadvertently give the wrong therapy.”
But not every patient can undergo biomarker testing.
When asked about biomarker testing in practice, only 67% of 2024 respondents said the majority of patients in their country undergo biomarker testing. That is a substantial improvement over 2018, when 39% of respondents said most patients undergo biomarker testing. But that still leaves 43% of respondents sometimes or often treating patients before receiving biomarker results.
Geography matters when it comes to biomarker testing access. Most respondents in high and upper-middle income countries said their healthcare system supports biomarker testing. Support fell to 19% in low- and lower-middle income countries. Six years after the original survey in 2018, the highest ranked barriers to optimal testing remain cost (27%), time (14%), sample quality (14%), access (13%), and awareness (8.0%).
Testing rates have improved since the initial survey, Dr. Smeltzer noted, but continued and substantial barriers to testing exist and are similar regardless of tumor stage. Solutions must focus on education, clinical processes, eliminating bureaucracy in government and payer organizations, and increasing funding, he said.
“A major takeaway is that we’ve had a paradigm shift in how we should think about biomarker testing,” Dr. Smeltzer said. “It’s no longer something that is nice to have for patients but is really a must-have for every patient.”
Dr. Smeltzer will present the results of the survey during a symposium titled Predicting the Future: Novel Pathology Assessments and Imaging Biomarkers, which will take place Sunday, September 8, from 10:45–12:00 PDT in Room 32AB. The session will be available on demand for registered WCLC 2024 attendees.
The 2024 survey was created by a global multidisciplinary committee that included medical oncology, pathology, pulmonology, surgery, epidemiology, and advocacy partners. The committee used a mixed methods approach that included focus groups and in-depth interviews to help inform survey results. The survey was available in English, French, Japanese, Chinese, Portuguese, and Spanish. Responses were translated into English for analysis.
