Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Retrospective audit of clinicopathological features and treatment in early-stage NSCLC – A real-world analysis of patient atezolizumab eligibility (#230)

Lucy Porter 1 , Phillip Parente 2 3 , Grace Gard 4 5 , Benjamin Brady 6 , Wasek Faisal 7 8 , Dishan Herath 4 , Margaret Lee 2 3 , Peter Gibbs 4 5 , Ben Markman 5 6 , Rachel Wong 2 3
  1. School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  2. Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia
  3. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
  4. Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia
  5. Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
  6. Department of Medical Oncology, Cabrini Health, Melbourne, Victoria, Australia
  7. Grampians Integrated Cancer Service, Grampians Health, Ballarat, Victoria, Australia
  8. School of Health, La Trobe University, Melbourne, Victoria, Australia

Aim: To determine potential adjuvant atezolizumab eligibility rates among non-small cell lung cancer (NSCLC) patients enrolled in a multi-site registry. Atezolizumab has been PBS-subsidised since November 2022 for resected stage II-IIIa NSCLC patients with PD-L1≥50%, with no EGFR/ALK gene abnormalities (confirmed on tumour testing) who have been treated with platinum-based chemotherapy. EGFR and ALK FISH tissue testing are not currently MBS-reimbursed for squamous cell carcinoma lung (SqCC). The proportion of patients who undergo genomic testing and are eligible for PBS-subsidised atezolizumab treatment in Australian hospitals is unknown.

Methods: Patients enrolled in the multi-site INHALE lung cancer registry between February 2020 and January 2023 at four Australian sites (n=448) were retrospectively analysed. NSCLC patients who underwent surgical resection were included (n=115) and analysed for stage, genomic testing, treatment details, and outcomes. 

Results: 90/115 resected NSCLC patients were treated with curative-intent. 77/90 had non-squamous histology. 63/90 received surgery alone, 25/90 received adjuvant systemic therapy and/or radiotherapy, and 2/90 received neo-adjuvant systemic therapy and/or radiotherapy. 70/90 curative-intent resected patients had PD-L1 testing. 56/90 underwent genomic testing. Of the 70 PD-L1 tested patients, 8 were PD-L1≥50%. One patient met current PBS-eligibility criteria for adjuvant atezolizumab. Reasons for being ineligible were: stage I tumour n=3, EGFR/ALK test not done n=2 (1 SqCC), and did not receive platinum-based chemotherapy n=2 (1 no EGFR/ALK mutations, 1 EGFR/ALK test not done).

Conclusion: In this real-world analysis of resected NSCLC patients, very few routine care patients were eligible for PBS-subsidised atezolizumab. We anticipate that PD-L1 and genomic testing rates will increase in response to the availability of adjuvant atezolizumab on the PBS and as evidence supporting neo-adjuvant/adjuvant use of immunotherapy and/or targeted agents continues to emerge. The discrepancy between PBS-eligibility requirements and MBS genomic testing reimbursement warrants review.