Treatment for many types of cancer is moving beyond "one-size-fits-all" chemotherapy and toward a personalized approach with precision medicine. This is certainly true for lung cancer, which is among the most common and deadly forms of cancer.1,2 Newer targeted therapies may give some patients the option to receive a treatment that is tailored to their lung cancer.
As the science progresses, however, ensuring both patients and healthcare providers are informed about the path from diagnosis to precision medicine treatment is key to giving them the tools they need to make informed treatment decisions.
"This starts with comprehensive biomarker testing," says Andrea Ferris, president and CEO of the lung cancer nonprofit, LUNGevity Foundation. Biomarker testing includes molecular or genomic testing, which examines a sample of a patient's blood or tumor tissue from a biopsy to look for unique mutations in the DNA of their tumor cells. These mutations not only provide insights into how certain cancers will grow, divide and spread, but they may also provide a target for cancer-fighting therapy.
"Comprehensive biomarker testing is one of the most important steps a person can take after being diagnosed with lung cancer," says Ferris.
Improving biomarker testing rates for patients with lung cancer by working together
Comprehensive biomarker testing can provide essential information about a number of mutations common in non-small cell lung cancer, but these tests are not uniformly offered or performed. In fact, Ferris says, "less than 50% of eligible patients with this type of lung cancer who are treated in community practices are tested for the recommended biomarkers and these numbers are lower for underserved populations."4
Because complex medical challenges like these are seldom solved by focusing on just one part of the problem, Amgen supports and engages with multiple partners who deploy varied approaches and work on different aspects of the problem. This includes LUNGevity, No One Left Alone and other organizations.
"We need to work collaboratively to enable healthcare systems and providers to utilize biomarker testing results at all appropriate points on a patient's treatment path," says Dr. Sumita Bhatta, Amgen's vice president and global medical therapeutic area head of oncology.
"At the same time," Dr. Bhatta continues, "we can also help make progress in improving biomarker testing rates by working alongside innovative and inspirational people and organizations to empower all patients to be active decision makers in their treatment."
Closing testing gaps through customized education and awareness efforts
Biomarker testing rates need to be improved overall, but as Andrea Ferris points out, they are particularly low in underserved communities. Tailoring educational efforts in these communities can help empower patients to ask about and understand their biomarker status and how it may inform their treatment path.
Among the programs Amgen is supporting with LUNGevity Foundation is No One Missed. Launched in April 2021, No One Missed encourages people diagnosed with non-small cell lung cancer to follow a Talk, Test, and Treat approach with their healthcare team and provides resources to patients and their caregivers to support their biomarker testing process.
This year, LUNGevity is conducting a targeted pilot program in Atlanta to expand its efforts to reach underserved Black and Hispanic/Latino patient populations. LUNGevity is partnering with patient ambassadors and working to reach patients through local media, community outreach and healthcare provider education, with plans to update and expand its efforts in 2023 to cities such as Chicago, Miami and Philadelphia based on results in Atlanta.
The campaign uses a surround-sound media approach to encourage patients to proactively speak to their doctors about comprehensive biomarker testing. "Through patient stories, health-literate materials and animation, and expert videos, the campaign greatly exceeded our goals for reach and traffic to the website," says Ferris. "We are building on our success nationally while refining our efforts to ensure underserved audiences have access to this resource."
Equipping cancer clinics in underserved communities to reduce barriers for their patients
Amgen is also supporting a study led by a nonprofit called No One Left Alone to develop best practices for incorporating comprehensive biomarker tests into patient care at community cancer clinics. This is aimed at closing a different testing gap—one created by location and social determinants of health, such as food insecurity and housing issues.
Less than half of clinicians in community care settings use biomarker testing to guide treatment decisions compared to three-quarters of clinicians at academic medical centers.5 This means suburban and rural residents who cannot access large medical centers, which tend to be in cities, are less likely to have access to testing.
Phase 1 of the study was piloted at three sites in South Carolina serving an ethnically diverse, rural population. Beyond the challenges of their geographic location, most patients in the study (58%) also had an annual household income level that is associated with having financial and food insecurity.
According to study lead Dr. Kashyap Patel, the pilot program has removed barriers encountered by patients, including mitigating financial burdens and improving health literacy. "Our efforts were very successful with our testing rate going up from 25% to 84%." Their work to overcome financial barriers was extensive, including raising money from local foundations to help cover direct and indirect patient costs and working with local laboratories to set up the genomic profile testing as a research study (and removing the co-pay costs).
Not only did testing rates increase, but the testing had clear value: one in four patients tested had "actionable" mutations (one for which a targeted therapy exists) and were switched to targeted cancer therapies for their specific mutation. Dr. Patel hopes to replicate his findings in the next phase of the study, which will expand to 15 sites serving more than 1,000 patients.
A final word from Dr. Bhatta
Progress in the development of precision medicine holds the potential for better outcomes, but also opens up new challenges — namely, finding ways to ensure everyone has equal access to biomarker testing.
"Everyone deserves the opportunity to be an active part of their healthcare decisions and to receive the same high level of care regardless of where they seek it, their health literacy or income level," says Dr. Bhatta. "For people with non-small cell lung cancer, this starts with everyone getting a comprehensive biomarker test, ideally during their initial diagnostic work up, so they can start on targeted therapy, if appropriate. It will continue to take strong alliances and multiple approaches to reach that goal for patients."
Amgen is working with or supporting more than 70 organizations through cross-sector collaborations, public-private partnerships and advocacy relations programs. Visit Amgen Patient Advocacy and Strategic Alliances to learn more.
- National Cancer Institute. Cancer statistics. https://www.cancer.gov/about-cancer/understanding/statistics. Accessed November 17, 2022.
- National Cancer Institute. Cancer stat facts: Common Cancer Sites. https://seer.cancer.gov/statfacts/html/common.html. Accessed November 17, 2022.
- American Cancer Society. Types of lung cancer. https://www.cancer.org/cancer/lung-cancer/about/what-is.html. Accessed November 17, 2022.
- Robert, N. J, et al. Biomarker testing and tissue journey among patients with metastatic non-small cell lung cancer receiving first-line therapy in The US Oncology Network. Lung cancer (Amsterdam, Netherlands). 2022;166:197–204.
- Leiser M. Biomarker testing decisions for lung cancer vary between academic, community oncologists. HemOnc Today. September 10, 2021. https://www.healio.com/news/hematology-oncology/20210910/biomarker-testing-decisions-for-lung-cancer-vary-between-academic-community-oncologists. Accessed November 17, 2022.
- Cox AD, et al. Drugging the undruggable RAS: Mission possible? Nature Reviews Drug Discovery. 2014;13(11):828-851.