EMBER-Lung: Electronic Medical Record Boosting Molecular Testing in Early-Stage Non-Small Cell Lung Cancer.

Abstract

Purpose: Adjuvant targeted therapies and perioperative chemoimmunotherapy have made it imperative to perform molecular testing in early-stage nonsquamous (NSq) non-small cell lung cancer (NSCLC). We present a prospective clinical trial evaluating an electronic medical record (EMR)-based nudge intervention to promote timely completion of comprehensive molecular testing (cMT) in patients with early-stage NSq NSCLC.

Methods: The EMBER-Lung trial prospectively enrolled patients undergoing surgical resection. The intervention included an EMR-based nudge at the time of the first postoperative visit, prompting the clinician to accept an order for cMT if NSq NSCLC histology. Following completion of cMT, if an actionable alteration was found, a reflex alert summarizing therapeutic options was sent to the patient's care team. The primary end point was the proportion of patients who underwent cMT in the real-world control and nudge intervention cohorts. Clinical characteristics and outcomes of the control and nudge intervention cohorts were compared using Pearson Chi-squared test, Fisher exact test, or Z score.

Results: Between July 2021 and November 2023, 460 patients were included (243 nudge and 217 control patients). The median age was 68.4 years, 64.3% female; 74.1% had a smoking history and mostly stage I (I/II/III; 75.9%, 14.1%, 10.0%, respectively). The proportion of patients with cMT increased in the nudge intervention (80/217, 36.9% v 197/243, 81.1%, P < .00001) across all stages (I to III). A greater proportion of patients with classical EGFR mutations and KRAS G12C mutations were detected in the nudge intervention setting (EGFR: 14/217, 6.5% v 41/243, 16.9%, P < .001; KRAS G12C: 12/217, 5.5%, v 33/243, 13.6%, P < .01).

Conclusion: In well-matched control and nudge intervention cohorts, an EMR-based nudge after resection of early-stage NSq NSCLC was feasible and increased the proportion of patients with cMT. Future research will incorporate this earlier, at the time of biopsy, to inform neoadjuvant therapy.