Aims: Investigate characteristics, testing patterns and first-line treatment (1L) in patients with RET fusion-positive (RET+) advanced non-small cell lung cancer (aNSCLC) in Australia.
Methods: Real-world data were collected from the Adelphi NSCLC Disease Specific Programme™, a cross-sectional survey of 30 oncologists/pulmonologists and their patients with aNSCLC, conducted during December 2022-June 2023. Physicians provided information on their next 8 consulting aNSCLC patients; 6 at random and 2 specifically RET+ [oversample].
Results: Data on 240 patients were collected; 193 random sample patients and 47 oversample patients. Within the random sample, 37% (n=71) had their RET fusion status known at advanced diagnosis (Adx), and n=1 identified as RET+. Of all RET+ patients at Adx (n=47), mean (SD) age was 59.0 (12.9), 49% were males, and 81% had an ECOG score of 0-1 at initiation of 1L treatment. Almost all RET+ patients (96%) had adenocarcinoma histology. RET - patients at Adx were mostly males (54%), 69% had an ECOG score of 0-1 and 81% had adenocarcinoma.
RET fusion status was primarily determined via Next-Generation Sequencing (NGS) (76%), with most samples collected by core needle biopsy (85%). RET results were received prior to 1L treatment for 85% of RET+ patients. Of all RET+ patients who were tested for PD-L1 (n=46), 57% had 1-49% expression and 17% had ≥50% expression.
The most common 1L regimen in the full aNSCLC sample was carboplatin+pemetrexed+pembrolizumab (23%) followed by pembrolizumab monotherapy (18%), whilst in the RET+ cohort selpercatinib was an equally prescribed 1L treatment to carboplatin+pemetrexed+pembrolizumab (both 26%).
Conclusion: This real-world study documented that RET testing at Adx is still not commonplace for patients. Where testing occurs, it is primarily through NGS and chemoimmunotherapy is predominantly used as 1L treatment. This highlights the need for increased RET testing at Adx and availability of RET selected therapies to improve patient outcomes.