Biomarker-Guided Adjuvant Treatment Supports Real-World Survival in Early NSCLC

Photo Credit: iStock.com/Mohammed Haneefa Nizamudeen

Biomarker-targeted adjuvant treatment was significantly associated with overall survival (OS) in patients with early non-small cell lung cancer (NSCLC), according to a real-world study presented at the 2025 ASCO Annual Meeting.

“Biomarker-targeted adjuvant treatment improves survival of patients with resected early-stage NSCLC, making thorough biomarker testing critical in this setting,” Raymond Osarogiagbon, MD, and colleagues wrote. “Disparities in testing and receipt of guideline-supported biomarker-targeted adjuvant treatment may adversely impact outcomes.”

Examining Survival in Resected NSCLC

Using Flatiron Health data, the researchers conducted a retrospective study of 885 patients with stage IB-IIIB NSCLC who were diagnosed between 2021 and 2023 and underwent resection. They examined biomarker testing rates, treatment rates, and clinical outcomes, including recurrence-free survival (RFS) and overall survival (OS).

Biomarker-targeted adjuvant treatment regimens included:

• osimertinib for EGFR-positive (Ex19del/L858R) NSCLC
• atezolizumab or pembrolizumab, according to PD-L1 status, for EGFR-negative and ALK-negative NSCLC

Treatment Disparities Identified

According to the findings, biomarker testing rates were lower in patients with lower-stage disease; 75% of those with stage I NSCLC underwent testing compared with 93% of patients with stage III NSCLC. In addition, testing rates were slightly lower for older versus younger patients (83% vs 87%), non-Hispanic Black versus White patients (74% vs 84%), and patients with versus without a history of smoking (83% vs 89%).

A total of 539 (61%) patients in the cohort received adjuvant therapy. Of these, 231 (43%) patients had actionable biomarkers, but only 137 (59%) received biomarker-targeted adjuvant treatment.

The researchers also found that biomarker-targeted adjuvant treatment rates were highest among patients with EGFR-positive NSCLC and lowest for those with EGFR/ALK-negative NSCLC (85% vs 49%, P<0.05). Rates were also higher among patients with no smoking history (76% vs 55% of patients who smoked, P<0.05) and patients with Asian ethnicity (100% vs 56% White, P<0.05).

At 24 months of follow-up, 90% of patients who received biomarker-targeted adjuvant treatment had survived, compared with 77% of patients who did not receive targeted therapy (P<0.05). Younger age was significantly associated with OS among those who received biomarker-guided treatment, according to the researchers’ multivariable analysis.

“In this large real-world analysis, biomarker-targeted adjuvant treatment was significantly associated with OS in early-stage NSCLC, irrespective of age, stage, and sex. Ensuring biomarker testing and biomarker-targeted adjuvant treatment for all patients may reduce outcomes disparities in NSCLC,” Dr. Osarogiagbon and colleagues concluded.

AstraZeneca funded the study.