Evaluating reflexive NGS and testing rates in community oncology.

Abstract

e23302 Background: In oncology, NGS allows for the identification of DNA sequence variations within a cancer. The goal of testing is to identify/define therapeutic targets & improve patient outcomes, employing specific therapies directed at those targets. In breast cancer, reflex tumor testing (ER/PR/Her2neu) has been performed for > 20 yrs. In CRC, as published by ASCO, guideline-adherent biomarker testing rates for RAS, BRAF, & MSI/MMR-d were 41%, 43%, and 51%, respectively1. In lung cancer, recent data has shown overall testing rates minimally better at 58%2. Methods: The study was conducted on historical data of lung, colorectal, and breast cancer patients seen in Verdi community oncology clinics between 4/1/2022-7/31/2023. Clinical & social health data were collected & abstracted from patient medical history (Doctor’s notes, Pathology studies, NGS results). The database contains demographic & clinical data features for each patient. Results: 153 lung cancer patients were identified, median age 71(44 – 96). 82 F, 71 M. 85% of patients were smokers (130 smokers, 22 non-smokers, 1 unknown). Self-identified race: Asian 1, Black 22, white 106, 24 patients declined to identify. 61.9% (65) of later stage (≥IIB) patients had NGS testing. Of 258 colon/rectal cancer patients (anal cancer was excluded), median age 67(29-96), 122 M,146 F. Self-identified race: Asian 3, Black 26, 181 white, 34 patients declined to identify, 14 were unknown. Overall, 34.5% (89) of patients had NGS testing, and 76.2% (34) of Stage IV patients. There were 511 breast cancer patients, median age 63(25-85), 506 F, 5 M. Self-identified race: Asian/HPI 2, Black 137, white 299, 56 patients declined to identify, 17 were unknown. 100% had NGS, with minimum testing of ER/PR/Her2neu status. In the lung & colorectal patients, statistically significant differences in rates of testing were seen in males (p < 0.0001), older age (p < 0.0001), and non-whites (p = 0.002). Conclusions: Testing at Verdi clinics were higher than reported testing. We propose that to improve testing rates, NGS should be reflexively ordered in other tumor types, as is the standard of care in breast cancer. This would eliminate many issues, including waiting time patients must undergo when testing is not ordered until the patient is seen by the medical oncologist. Proactive testing allows potential targeted treatments to be delivered in real-time and thus improve patient outcomes. 1Genomic Profiling for KRAS, NRAS, BRAF, Microsatellite Instability, and Mismatch Repair Deficiency Among Patients With Metastatic Colon Cancer. JCO Precision Oncology (2019)3(3). 2Improving biomarker testing in advanced non-small cell lung cancer and metastatic colorectal cancer: experience from a large community oncology network in the USA. Future Oncology (2023)19(20),1397-1414.