Impact of Reflex EGFR/ALK Testing on Time to Treatment of Patients With Advanced Nonsquamous Non-Small-Cell Lung Cancer

Purpose Optimal first-line systemic therapy for patients with advanced nonsquamous (nonsq) non-small-cell lung cancer (NSCLC) requires confirmation of EGFR/ALK status, which can delay treatment. We evaluated the impact of reflex testing, defined as pathologists initiating EGFR/ALK testing at the time of diagnosis of nonsq NSCLC, on time to treatment (TTT). Methods We conducted a retrospective review of patients with nonsq NSCLC with medical oncology consultation at Sunnybrook Odette Cancer Centre between March 18, 2010 and April 30, 2014. Data were compared during routine and reflex testing. TTT was defined as the interval between the first medical oncology visit with advanced NSCLC and the initiation of systemic therapy. Results A total of 306 patients were included (n = 232 for routine testing, n = 74 for reflex testing). There wasa trend to improvement in medianTTTwith reflex testing (36 days [interquartile range {IQR}, 16 to 71 days v 26 days [IQR, 8 to 41 days], P =.071). Omitting patients with intentional delays in systemic therapy for low-volume disease, poor performance status, comorbidity management, and/or radiation therapy, median TTT improved (34 days [IQR, 15 to 67 days] v 22 days [IQR, 8 to 42 days], P =.049). Time to optimal first-line systemic therapy according to published guidelines improved (median, 36days [IQR, 16to91 days] v 24 days [IQR, 8 to 43 days], P =.036). There was no impact on receipt of any first-line systemic therapy (55% v 59%, P =.66). The quality of biomarker testing improved, with fewer unsuccessful tests (EGFR, 14% v 4%, P =.039; and ALK, 17% v 3%, P =.037). Conclusion Reflex testing of EGFR/ALK improved the time to optimal systemic therapy and the quality of biomarker testing for patients with advanced nonsq NSCLC.