The 2024 IASLC global survey on biomarker testing

Despite significant improvements in the perception of biomarker testing compared to a 2018 survey, the 2024 International Association for the Study of Lung Cancer (IASLC) global survey on biomarker testing revealed that there are still substantial barriers to implementation globally.

In 2018, the survey revealed that the adoption of biomarker testing was still low, mainly due to high costs, the lack of quality and standards, access, awareness and long turnaround times. Since 2018, numerous therapeutic advances have been made in late-stage and early-stage lung cancer. Therefore, the IASLC and partners launched the second global survey on biomarker testing in spring of 2024, as part of a larger initiative.

Survey

The survey was set up by a global, multidisciplinary team, including medical oncology, pathology, pulmonology, surgery, epidemiology, and advocacy partners. The survey was available in six languages (English, French, Japanese, Chinese, Portuguese, and Spanish) and was translated into English for analysis. The survey contained sections on demographics, current practices and perceptions, pathology, ordering tests or treatment, acquiring tissue, barriers to optimal testing, and potential solutions. Responses were grouped by IASLC global region and by High/Upper-Middle income countries (HUMIC) and Low/Middle income countries (LMIC).

Results

In total, there were 1,677 evaluable responses, across 90 countries and 14 disciplines. Almost all respondents (98.3%) believe biomarker testing significantly impacts outcomes and 91.2% have a clear understanding of who should receive testing. However, only 63.4% and 29.4% ranked it highly important to perform biomarker testing in late- and early-stage, respectively. In the study, 67% of respondents reported that more than half of lung cancer patients receive biomarker testing in their country, a significant increase from the 39% reported in 2018 (p< 0.0001). Notably, 43% sometimes/often treat patients prior to receiving biomarker results. The highest ranked barriers to biomarker testing were cost (27.2%), time (13.9%), sample quality (13.8%), access (12.8%) and awareness (8.0%).

Non-surprisingly, respondents from HUMIC expressed greater healthcare system support for biomarker testing (65.4%) compared to those from LMIC, where only 18.6% noted similar support. Respondents indicated that testing costs have partial reimbursement (37%), full reimbursement (25%), limited reimbursement (18%) or no reimbursement (13%). Median (IQR) tissue testing turnaround time was 14 (10) days, with no consensus on one particular source of increased turnaround time. Pathologists reported insufficient tissue as the most impactful reason testing is not performed in late-stage (48%).

Finally, respondents advocated for numerous solutions, including (in order of occurrence) implementing testing protocols, government-level interventions, addressing cost/reimbursement, awareness/education, support and access/availability research. The IASLC is now launching a series of initiatives using these data to target awareness, access, processes and policy.

Conclusion

The 2024 IASLC survey found improvements in the perception of testing rates compared to 2018 but continued and substantial barriers in testing exist. These barriers are similar regardless of tumour stage. Key solutions focused on education, clinical processes, eliminating bureaucracy in government and payer organisations and increasing funding.

Reference

Smeltzer M, et al. The 2024 International Association for the Study of Lung Cancer (IASLC) Global Survey on Biomarker Testing. Presented at WCLC 2024; Abstract OA0.03.