Variations in Utilization and Sequencing Observed in Biomarker Testing Among Patients With Advanced NSCLC

Data from a study in the Netherlands found substantial variation in biomarker testing among 102 patients with advanced non–small cell lung cancer.

A study published in The Journal of Molecular Diagnostics analyzing variations in biomarker testing in clinical practice for patients with advanced non–small cell lung cancer (NSCLC) found substantial variation in both test utilization and sequences.1

When taking into consideration current costs of biomarker testing, the research team concluded that replacing current biomarker testing with whole-genome sequencing resulted in cost savings for only 2% of patients included in the research.

“While there is a lot of interest in the use of real-world data to analyze treatment variation and outcomes, this study demonstrates the importance of identifying variation in the use of molecular tests as the gateway to most cancer treatments,” lead investigator Professor Maarten IJzerman of the University of Twente in Enschede, the Netherlands, said in a press release.2

The team of investigators analyzed the biomarker testing history of 102 patients with stage IV NSCLC previously referred to a comprehensive cancer center in the Netherlands. The group of eligible patients were recruited utilizing the linked pathology data from referring hospitals.

Overall, the mean cost for biomarker testing for each patient was $2258.52, or €1881.23. Of note, the number of patients who would see a decreased or equal cost for testing if the entire test sequence was replaced by whole-genome sequencing ranged from 2 to 29 patients, depending on the assumed cost for each.

Of the 102 patients included in the population, investigators observed unique biomarker combinations in 99 patients, with almost none of the patients undergoing the same tests in the same order. The usual practice was to test common biomarkers first with emerging biomarkers tested later.

Another difference noticed in the research was the variance in the number of tests taken by each patient. Tests were completed at different times, with most patients completing more than 1 test.

“We have shown that it is currently unlikely that replacing the current practice of molecular testing in lung cancer with whole-genome sequencing will be cost saving,” first author Michiel van de Ven, PhD candidate, of the University of Twente in Enschede, The Netherlands, said in a press release. “Yet, for whole-genome sequencing to be routinely used, there are other aspects where it adds value, such as the discovery of other driver mutations not routinely tested for and the potential to streamline diagnostic workflows.”

One limitation of the research is that the generalizability of the data might be limited given that comprehensive cancer centers might use a more elaborate test strategy to determine patient eligibility for enrollment on clinical trials when compared with other nonacademic and nonspecialized hospitals.

More, the costs of testing could be hard to generalize as well because the costs are specific to each setting, suggesting that the same tests from different centers could be priced differently. The estimates were likely accurate of the national average in the Netherlands but generalizing these costs to other countries remains a challenge.


1. van de Ven M, Koffijberg H, Retel V, et al. Real-World Utilization of Biomarker Testing for Patients with Advanced Non-Small Cell Lung Cancer in a Tertiary Referral Center and Referring Hospitals. J Mol Diagn. 2021;23(4):484-494. doi: 10.1016/j.jmoldx.2021.01.004

2. Significant variation found in timing and selection of genetic tests for non-small cell lung cancer. News release. Elsevier. Published March 15, 2021. Accessed March 29, 2021.