Biomarker testing patterns among patients newly diagnosed with metastatic non-small cell lung cancer, prostate cancer, and bladder cancer

Sep 22, 2026

National clinical guidelines recommend biomarker testing to identify actionable molecular alterations and enable personalized treatment. This retrospective database study examined testing patterns in adults newly diagnosed with metastatic NSCLC, prostate cancer, or bladder cancer treated in a large community oncology network in the West South-Central United States from January 2018 to December 2022. Testing rates, timing, actionable findings, targeted therapy use, and treatment switches after positive results are reported.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Implications for Practice

The Oncologist, 2026, 31, oyag243 [https://doi.org/10.1093/oncolo/oyag243](https://doi.org/10.1093/oncolo/oyag243) [Published: June 27](Published: June 27), 2026 Original Article Biomarker testing patterns among patients newly diagnosed with metastatic non-small cell lung cancer, prostate cancer, and bladder cancer Siraje Mahmud1,†, , Lisa Dwyer Orr*,2,†, , Mika Cline3, , Ayda Mirsalehi1, , Monica Lisi1, , Laura Ensley1, , Lorraine Brisbin1, , R. Steven Paulson3, 1 Precision Health Informatics, LLC, Dallas, TX 75251, United States 2Johnson & Johnson, Titusville, NJ 08560, United States 3Texas Oncology, Dallas, TX 75251, United States *Corresponding author: Lisa Dwyer Orr, MPH, Johnson & Johnson, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560, USA ([ldwyer2@its.jnj.com](ldwyer2@its.jnj.com)) . †These authors provided equal contributions to this work. Abstract Background: National clinical guidelines recommend biomarker testing to identify actionable alterations across cancers, supporting personalized treatment. Methods: This retrospective database study characterized biomarker testing patterns among adult patients newly diagnosed with metastatic non-small cell lung cancer (NSCLC), prostate cancer, or bladder cancer (January 2018–December 2022), receiving care within a large regional community oncology network in the West South-Central United States. Results: Of 18 491 patients with NSCLC, 20 810 with prostate cancer, and 4120 with bladder cancer, 7383 (40%), 4985 (24%), and 888 (22%), respectively, had metastatic disease. For these metastatic subgroups, biomarker testing rates were 80%(NSCLC), 34%(prostate), and 42%(bladder). Median time from disease diagnosis to first test order was 10 days (NSCLC), 98 days (prostate), and 23 days (bladder), with differences observed across racial and ethnic groups. Among tested patients, actionable mutations were identified in 29%(NSCLC), 25%(prostate), and 14%(bladder) of patients, and targeted therapy was received by 54%, 15%, and 38% of these patients, respectively. Among patients who initiated treatment prior to receipt of test results, 72%(NSCLC), 12%(prostate), and 30%(bladder) subsequently switched to targeted therapy following a positive result. Testing rates increased between 2018 and 2022 for all cohorts; result turnaround times improved in prostate and bladder cancers. Conclusions: Biomarker testing was highest in metastatic NSCLC and lower in prostate and bladder cancer in this community oncology setting. Despite improvements over time, gaps remain in timely testing and use of targeted therapies, highlighting opportunities to optimize precision oncology implementation. Key words: non-small cell lung cancer; prostate cancer; bladder cancer; biomarker; molecular analysis Implications for Practice Molecular biomarker testing among patients newly diagnosed with metastatic non-small cell lung cancer has improved in community settings in the United States but remains lower and more variable for those newly diagnosed with prostate or bladder cancer. Realizing the benefits of targeted therapies depends on timely and appropriate testing. This study highlights the need to address both educational and system-level barriers to biomarker testing in community practice, including workflow, access, and turnaround time challenges. Efforts to standardize testing pathways and improve care coordination may help advance more equitable implementation of precision oncology. Received: February 3, 2026. Accepted: June 22, 2026 © The Author(s) 2026. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Biomarker testing is central to precision onco

FAQs

What question does the study address about biomarker testing?

It evaluates biomarker testing patterns for patients newly diagnosed with metastatic NSCLC, prostate cancer, or bladder cancer, including testing rates, timing, and downstream treatment actions.

How were patient cohorts and the study period defined?

The study retrospectively analyzed adult patients newly diagnosed with metastatic disease who received care within a large regional community oncology network from January 2018 to December 2022.

What were the main findings on testing rates and actionable mutations?

Biomarker testing was highest in metastatic NSCLC and lower in prostate and bladder cancer. Among tested patients, actionable mutations were identified at reported rates across the three cancer types, with targeted therapy received by a subset of tested patients.

Why do the authors say biomarker testing gaps remain important?

They report improvements over time but highlight persistent gaps in timely testing and use of targeted therapies, emphasizing opportunities to optimize precision oncology implementation.

Sep 22, 2026

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