背景:在转移性NSCLC(mNSCLC)管理的动态环境中,以几个前线选项和下一代测序(NGS)的整合为标志,以进行明智的决策,尽管取得了进步,但障碍仍然存在。这包括临床试验招募中的挑战。为了获得对临床医生实践的全球洞察力,我们对mNSCLC患者的检测和管理方法进行了调查.
方法:调查,于2023年7月12日至8月20日进行,利用多项选择题和定性研究问题,采用李克特量表获得全面的见解。
结果:总共127个人回答,72%隶属于学术卫生系统,55%在美国执业。关于测试实践,93%的人一致订购了非鳞状组织学的NGS,而54%的人在鳞状细胞组织学上这样做。同时组织和液体活检常规订购28%,而39%的人报告仅针对特定案例同时订购两个测试平台。受访者列举了后勤障碍,例如组织不足和缺乏基础设施,作为分子检测最常见的障碍(76%),其次是报销挑战(56%)和对延迟周转时间的担忧(50%)。虽然大多数受访者对解释NGS结果充满信心,22%的人缺乏信心。关于治疗决定,72%的人首选在开始全身治疗前等待分子检测结果。不到50%的患者在mNSCLC一线进行常规转诊进行临床试验。对于表达高PD-L1水平的疾病患者,大多数肿瘤学家首选pembrolizumab单药治疗.对于PD-L1低表达的疾病,铂类双联化疗方案联合派博利珠单抗方案受到青睐.在PD-L1表达阴性的疾病病例中,pembrolizumab的铂类双联化疗方案是首选.影响肿瘤学家首选免疫检查点抑制剂(ICI)的关键因素包括与一种ICI相比于另一种ICI的经验,根据国家准则,首选地位,具有重要随访期的试验数据的可用性,以及药品成本的考虑。
结论:尽管这项研究表明,在mNSCLC的管理中,人们对订购NGS的认识和采用有所提高,它强调了必须解决的各种障碍的持续存在,以改善诊断为mNSCLC的患者的护理质量.
BACKGROUND: 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.
CONCLUSIONS: 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.