{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:51:24Z","timestamp":1791265884815,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Purpose<\/jats:title>\n                    <jats:p>Biomarker testing and matched therapies are central to precision oncology, but their real\u2010world uptake and clinical impact among older adults with advanced solid tumors remain poorly characterized. This retrospective observational cohort study assessed biomarker testing and guideline\u2010concordant matched first\u2010line therapy use and evaluated their associations with overall survival, diagnosis\u2010to\u2010treatment intervals, and 6\u2010month physical functioning in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>\n                      This study used linked US Medicare claims, electronic medical records, and patient\u2010reported outcomes of fee\u2010for\u2010service beneficiaries \u2265\u200965\u2009years with incident advanced\/metastatic non\u2010small cell lung cancer, breast, colorectal\/gastric, or urothelial cancer. Biomarker testing (\u2264\u200930\u2009days pre\u2010diagnosis through first\u2010line therapy initiation) and guideline\u2010concordant matched targeted or immunotherapy\u2010based first\u2010line treatment (defined as first\u2010line initiation of a targeted or immuno\u2010oncology agent whose approved indication corresponded to the patient's actionable biomarker within the study period [Table\u00a0]) were assessed. Primary outcomes were overall survival, time to first\u2010line therapy, and 6\u2010month physical functioning. Associations were estimated using inverse probability\u2013weighted Cox proportional hazards and marginal structural models; residual confounding was probed with\n                      <jats:italic>E<\/jats:italic>\n                      \u2010values and landmark sensitivity analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 39,964 beneficiaries with advanced cancers, 21.6% underwent biomarker testing. Actionable alterations were identified in 9.8% of patients, of whom 62.0% received matched first\u2010line therapy. Testing modestly increased median diagnosis\u2010to\u2010treatment intervals, but delays beyond tumor\u2010specific medians were not associated with excess mortality. Biomarker testing was associated with longer overall survival, and matched first\u2010line therapy was associated with higher 6\u2010month physical functioning across all cohorts (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Biomarker testing and matched first\u2010line therapies were underused but associated with longer overall survival and better physical functioning. Residual confounding is possible and the magnitude of the testing\u2010survival association likely partially reflects selection of fitter patients into testing. Modest testing\u2010related treatment delays were not associated with worse survival, supporting expansion of routine biomarker testing in Medicare oncology practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72279","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:39:02Z","timestamp":1790231942000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Targeted Therapy, Immunotherapy, and Molecular Testing in Advanced Solid Tumors: A Medicare Analysis"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7447-5672","authenticated-orcid":false,"given":"Onur","family":"Baser","sequence":"first","affiliation":[{"name":"Department of Economics Bo\u011fazi\u00e7i University  Istanbul Turkey"},{"name":"School of Public Health City University of New York  New York New York USA"},{"name":"Columbia Data Analytics  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6901-8411","authenticated-orcid":false,"given":"Yijia","family":"Sun","sequence":"additional","affiliation":[{"name":"Columbia Data Analytics  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/OP.23.00601"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41571\u2010023\u201000824\u20104"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.19972"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41392\u2010024\u201001823\u20102"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.19963"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/PO\u201024\u201000449"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2025.31.6\u2010a.s1"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol31030115"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdv208"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.6886"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd\u201024\u20102007"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15051595"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40487\u2010023\u201000234\u20107"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.molonc.2015.05.004"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13040782"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.7326\/M21\u20104109"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/11795549241298541"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.5785"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djz173"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/14796694.2024.2404268"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(07)61602\u2010X"},{"key":"e_1_2_11_23_1","unstructured":"National Comprehensive Cancer Network \u201cNCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Non\u2010Small Cell Lung Cancer. 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