Impact of next generation sequencing on a clinicians’ first line treatment decision in patients with stage IV non-small cell lung cancer.

Abstract

e21160 Background: National Comprehensive Cancer Network (NCCN) guidelines strongly recommend biomarker testing for patients with advanced non-small cell lung cancer (NSCLC), specifically with broad, panel-based sequencing via NGS. Our study characterized how clinicians utilized NGS testing to make first line treatment decisions in patients with stage IV NSCLC. Methods: We conducted a cross-sectional study of members within an integrated healthcare system (Kaiser Permanente Southern California) diagnosed with stage IV NSCLC who completed NGS testing (Strata Oncology) between May 2019 to June 2021. Treatment start dates were used to divide patients into those who started treatment before and after NGS results, and those who did not receive treatment after NGS results. Patients harboring alterations in seven genes (EGFR, ALK, ROS-1, BRAF, KRAS, RET, and MET) were considered candidates for targeted first line therapy. Results: A sample of 760 patients with stage IV NSCLC completed NGS testing. The mean time from NGS order to result was 25 days. Of the 760 in the sample, 284 (37%) and 262 (34%) initiated treatment before and after NGS results were reported, respectively, while the remaining 214 (28%) did not receive any treatment up to 120 days after the NGS results were reported. 43% (323/760) of the sample was found to have a targetable mutation on NGS, of whom only 38% (124/323) initiated first line treatment with a targeted therapy. 56/124 (45%) were treated with targeted therapy prior to NGS results and 68/124 (55%) were treated with targeted therapy after NGS results. 61% (118/193) of EGFR, ALK, or ROS mutated patients started targeted therapy. 67/323 with a driver mutation did not receive any treatment and were referred to hospice. For those patients who initiated targeted therapy prior to NGS results, it suggests that clinicians ordered single gene testing in parallel with NGS, and that these results were available prior to NGS. Conclusions: NGS tests results were not exclusively used to inform first line treatment decisions in most patients with stage IV NSCLC, as most patients found to have a targetable mutation, were not treated with targeted therapy. Possible explanations include lengthy turnaround times for NGS testing and the availability of more timely single gene testing.