The landscape of lung cancer biomarker testing continues to face significant challenges despite growing recognition of its importance, according to findings from a global survey presented at the 2024 IASLC World Conference on Lung Cancer. The survey, conducted by the International Association for the Study of Lung Cancer (IASLC), reveals both progress and persistent barriers in implementing optimal biomarker testing protocols.
Key Survey Findings and Progress
The survey, encompassing 1,677 responses from healthcare professionals across 90 countries, demonstrates substantial progress in biomarker testing adoption. Notably, 63.4% of respondents prioritized testing for late-stage lung cancer, while 29.4% emphasized its importance in early-stage cases. The perception of testing rates has significantly improved, with 67% of respondents believing that more than half of lung cancer patients in their country receive testing, up from 39% in 2018.
Persistent Barriers to Implementation
Despite widespread acknowledgment of biomarker testing's crucial role, with 98.3% of respondents believing it significantly impacts outcomes, several key barriers continue to impede optimal implementation:
Cost emerged as the primary obstacle, cited by 27.2% of respondents. The survey revealed varying reimbursement landscapes:
- 25% reported full reimbursement for all tests
- 37% indicated partial reimbursement based on specific criteria
- 18% faced limited reimbursement
- 13% had no reimbursement system
Turnaround time presents another significant challenge, with a median of 14 working days for tissue testing. According to Dr. Matthew Smeltzer, associate professor at The University of Memphis, "43% said they sometimes often treat patients prior to receiving the biomarker results. This is not what we want to happen."
Sample Quality and Technical Challenges
Insufficient tissue samples remain a critical issue, particularly for late-stage lung cancer patients. Pathologists identified insufficient tumor cells as the primary reason for testing failure in 48% of cases. This challenge affects both initial diagnosis and re-biopsy requests for early-stage lung cancer patients.
Solutions and Future Directions
Healthcare professionals suggested several potential solutions to address these challenges:
- 63% recommended educating decision-makers on cost-effectiveness
- 55% advocated for working with policymakers on reimbursement
- 49% suggested innovative cost-sharing agreements with diagnostic companies
- 41% proposed cost-sharing arrangements with payers
Dr. Smeltzer emphasized the potential role of alternative testing methods: "Liquid biopsy is another available tool when the tissue is not available. We need to be open to new technology and figure out how to rigorously develop it."
Awareness and Education
The survey highlighted ongoing needs in awareness and education. While 54% of institutions use CAP-IASLC-AMP biomarker testing guidelines, 26% remain unaware of any guidelines. Additionally, 68% of respondents emphasized the critical importance of patient education following diagnosis.
"A major takeaway is we've really had a paradigm shift in how we should think about biomarker testing," Dr. Smeltzer concluded. "It's no longer something that's nice to have for our patients, but it's really a must-have for every patient with lung cancer."
