(089) Evaluation of Biomarker Testing Practices Across Different Settings of Care for Advanced and Metastatic Gastrointestinal Cancers

Poster Abstract:

Background:
Biomarker testing when conducted appropriately aids clinicians in making informed decisions surrounding patients’ prognoses, goals of care, and personalized anticancer treatment. Guidelines published by the National Comprehensive Cancer Network (NCCN) alongside the College of American Pathologists (CAP), American Society of Clinical Pathologists (ASCP), and American Society of Clinical Oncology (ASCO) advocate for testing in advanced and metastatic gastrointestinal malignancies to improve clinical outcomes. Testing assays may include immunohistochemistry and/or next generation sequencing depending on cancer-specific considerations. Despite this, studies suggest a deficiency of testing in routine clinical practice. While rates have improved in recent years, one nationwide retrospective study of over 1,000 patients revealed that biomarker testing for programmed cell death-ligand 1 (PD-L1) and microsatellite instability (MSI)/mismatch repair (MMR) was limited to 58% of patients in 2020. Within Yale New Haven Health System (YNHHS), Smilow Cancer Hospital provides patient-centered cancer care across its flagship academic medical center and fifteen community care centers across Connecticut and Rhode Island. This study aims to compare and characterize biomarker testing in advanced or metastatic gastrointestinal cancer treatments across the ambulatory academic medical center and community care center settings at YNHHS.

Objective(s):
The primary objective is to determine the percentage of patients that received appropriate biomarker testing in the academic medical center and community care settings for advanced or metastatic gastrointestinal cancers. The secondary objectives are to determine the percentage of initial treatment selections guided by available biomarker testing results, identify barriers for biomarker testing, and evaluate equity in patient access to biomarker testing based on insurance coverage status.

Methods:
This is a single center retrospective chart review of patients diagnosed with primary gastrointestinal malignancies at YNHHS from September 1, 2022 to August 31, 2023. Patient eligibility criteria includes ages 18 years and older along with a primary diagnosis of advanced or metastatic gastric, esophageal, esophageal-gastric junction, colon, or rectal cancer. Exclusion criteria includes a secondary cancer diagnosis or receipt of initial treatment during hospitalization. Data points collected include patient demographics, biomarker testing characteristics (i.e., biomarkers tested, internal vs. external analysis), time from sample collection to test result, time from test result to treatment initiation, test result availability before treatment initiation, and type of insurance coverage or uninsured.

Results:
Results pending

Discussion/

Conclusions:
Results pending

References (must also be included in final poster): Mehta R, et al. Curr Oncol. 2023;30(2):1869-81.

Sarhadi VK, et al. Biomolecules. 2022;12(8):1021.

Bartley AN, et al. J Clin Oncol. 2017;35(4):446-64.

Sepulveda AR, et al. J Clin Oncol. 2017;35(13):1453-86.

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Gastric Cancer V.1.2023. © National Comprehensive Cancer Network, Inc. 2023. All rights reserved. Accessed [August 29, 2023].

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colon Cancer V.2.2023. © National Comprehensive Cancer Network, Inc. 2023. All rights reserved. Accessed [August 29, 2023].