Two new studies—presented by Drumheller et al and Vento et al at the 2023 ASCO Quality Care Symposium—utilized data from ASCO’s CancerLinQ® database (Abstracts 418 and 532). One study revealed deficiencies in biomarker testing and tracking in electronic health records, and the other analyzed immunotherapy trends in renal cell carcinoma.
CancerLinQ was developed and implemented by ASCO to improve the quality of care for patients with cancer as well as advance evidence-based research.
Findings From the First Study
In the first study, investigators tested the implementation of three versions of the technical specifications of an electronic clinical quality measure—“BRAF Mutational Analysis Results Received for Patients Treated for Metastatic Colorectal Cancer”—against data from 61 organizations and multiple electronic health record systems in the CancerLinQ database. The investigators analyzed the availability of required data elements in native and curated data, as well as variability and frequency of testing documentation for BRAF mutations.
They found that BRAF mutation information was frequently not available in structured data fields and often lacks specificity for the specific variant tested, making the measure unsuitable for consensus endorsement or use in federal reporting programs. Although the implementation of the measure in CancerLinQ was infeasible as a result of the data gaps noted, the researchers noted that their findings were important in revealing current shortcomings in reporting and exchanging molecular data in electronic health records.
The investigators in this study emphasized that there remains an ongoing need for measure stakeholders to advance electronic clinical quality measure standards necessary for supporting future measure deployment.
Findings From the Second Study
In the second study, investigators used the CancerLinQ Discovery kidney cancer data set to analyze the trends in uptake and efficacy of immuno-oncology drug combinations as front-line treatment in 515 patients with metastatic clear cell renal cell carcinoma from 2018 to 2022. The investigators found that 44.3% of the patients received a combination of two immuno-oncology agents, 29.7% of them received an immuno-oncology agent and a tyrosine kinase inhibitor, and 23.7% of them received immuno-oncology monotherapy.
An increasing trend in the use of immuno-oncology agents in combination with tyrosine kinase inhibitors was noted from 2019 to 2021. The median time to treatment discontinuation for patients who received ipilimumab plus nivolumab was 8.5 months and for those who received pembrolizumab plus axitinib was 11.0 months. When compared to progression-free survival from landmark trials, the results demonstrated a shorter time to treatment discontinuation—suggesting either an underestimation of the true progression-free survival or worse outcomes in this real-world population.
These investigators concluded that their new findings highlighted the significance of studying outcomes of newly approved agents and combinations for patients with metastatic disease using real-world data sets, where many patients may not have been candidates for clinical trial inclusion as a result of comorbidities, advanced age, or other factors.