Challenges in the management of advanced NSCLC among Italian oncologists: a 2019 national survey unfolds regional disparities

Background: Molecular testing is crucial for the implementation of personalized therapy in patients with lung cancer. Whether routine biomarker testing and access to personalized therapies are limited in some Italian regions is unclear. Patients and Methods: We conducted a national cross-sectional survey between April and June 2019 among Italian oncologists to determine differences in biomarker testing and access to personalized therapies for lung cancer. Results: Based on GIMBE report n. 3/2018, 32 respondents (37.6%) were defined as belonging to budget deficit regions (BDRs) while 53 (62.4%) were from balanced/positive budget regions (BPRs). Diagnostic assays for EGFR/ALK/ROS1 and PD-L1 were reported to be available in 47/53 (88.7%) and 22/32 (68.85%) centers from BPRs and BDRs, respectively (p=0.04). Liquid biopsy accessibility was wider in BPRs than in BDRs (75.5% (40/53) vs. 50% (16/32), respectively; p=0.03). 84/85 (98.8%) oncologists reported that ⩾75% of eligible patients received first-line targeted therapies. Reason for not administering first-line targeted therapies was defined as clinically-unrelated (molecular testing not available or incomplete, pharmacoeconomic issues) by 25/42 (59.5%) of respondents from BPRs and 21/26 (80.6%) from BDRs (p=0.12). Reason for not administering first-line pembrolizumab was defined as clinically-unrelated by 8/43 (18.6%) of respondents from BPRs and 10/22 (45.4%) from BDRs (p=0.039). Conclusion: Disparities in access to diagnostic assay and first line immunotherapy exist between BPRs and BDRs.