P24.12 Biomarker Testing for Advanced Lung Cancer by Next-Generation Sequencing in Elderly Patients

Abstract

The Next Generation Sequencing (NGS) -based assay to find an actionable driver in non-small cell lung cancer is a modality with increasing use in clinical practice with an economic impact in developing countries. With a long list of actionable targets, limited tissue samples, and arduous single gene assays, the NGS alternative for extensive testing in clinical practice is attractive and useful even in the elderly population, in order to avoid turnaround time delays as well as allocate patients in target therapies avoiding toxic treatments. We present here our experience with NGS-based biomarker testing, focusing on patients with Non-small cell lung cancer (NSCLC) older than 75 years. A retrospective observational study was conducted. Consecutive stage-IV NSCLC patients with NGS predictive biomarker testing were included. Predictive biomarker testing was performed in each patient/case using either Foundation Liquid biopsy™ Solid Tumor DNA or Oncomine Focus Assay™ on Ion-Torrent sequencing platforms. Molecular testing was carried out in the setting of the Hospital Italiano de Buenos Aires, Argentina in patients with unresectable/advanced NSCLC and >75 years old. 36 patients were older than 75 years with a median age of 79.5 years (r75-90) being 63.8% men (23/36). Within the analyzed >75-year cohort, 36% were non-smokers, and regarding the histological subtype, 91% of them were adenocarcinoma. Focusing on the elderly population, the following molecular alterations were found: EGFR (n=9, 25%), KRAS G12C (n=4, 11.1%), c-Met mutation or amplification (n= 3, 8%), rearrangements in ALK (n=2, 5.5%) and ROS-1 (n=1, 2.7%). None actionable molecular alterations were found in 18 patients (50%). Molecular alterations with approved drugs were detected in 36% of patients. Adding the possibility of entering a clinical trial, an expanded access or compassionate use program, the prevalence rises to 53%. Only 5.5% (2 patients) of this group did not access the drug due to clinical deterioration. This is a relevant study for elderly population with stage IV NSCLC describing the mutational landscape of lung cancer patients on cancer biology and treatment outcome. Our study demonstrates the clinical utility of NGS testing for identifying actionable variants and treatment decision-making in advanced lung cancer in elderly population.