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Broad-Based Genomic Sequencing in Advanced NSCLC in the Community Oncology Setting

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Key Points

  • Broad-based genetic sequencing informed treatment in 4.5% of patients.
  • Overall, broad-based genetic sequencing was not independently associated with improved survival. 

In a study reported in JAMA, Presley et al found that use of broad-based genomic sequencing vs routine testing for EGFR mutations or ALK rearrangements alone directed treatment in a minority of patients with advanced non–small cell lung cancer (NSCLC) in the community oncology setting and was not independently associated with improved survival.

Study Details

The retrospective cohort study involved 5,688 patients with advanced NSCLC who received care between January 2011 and July 2016 at 191 oncology practices within the US Flatiron Health Database. Patients were diagnosed with stage IIIB or IV or unresectable nonsquamous NSCLC and had received ≥ 1 line of antineoplastic treatment. Patients had a median age of 67 years, 64% were white, and 80% had a history of smoking.

Use of Broad-Based Sequencing

Among the 5,688 patients, 875 (15.4%) received broad-based genomic sequencing and 4,813 (84.6%) received routine EGFR/ALK testing. Among those receiving broad-based genomic sequencing, 4.5% received targeted treatment based on testing results, 9.8% received routine EGFR/ALK-targeted treatment, and 85.1% received no targeted treatment.

At 12 months, unadjusted mortality rates were 49.2% among patients undergoing broad-based genomic sequencing vs 35.9% among those undergoing routine testing. On instrumental variable analysis, the predicted probability of death at 12 months was 41.1% for broad-based genomic sequencing vs 44.4% for routine testing (difference = −3.6%, P = .63). Kaplan-Meier survival analyses among the full population showed a difference favoring broad-based genomic sequencing in unadjusted survival curves (hazard ratio [HR] = 0.69, P < .001). In a propensity score-matched analysis, no significant difference was observed (12-month survival = 42.0% vs 45.1%, HR = 0.92, P = .40).

The investigators concluded, “Among patients with advanced non–small cell lung cancer receiving care in the community oncology setting, broad-based genomic sequencing directly informed treatment in a minority of patients and was not independently associated with better survival.”

The study was funded by grants from the Veterans Affairs Robert Wood Johnson Clinical Scholar Program and the Yale Lung SPORE Career Development Award.

Carolyn J. Presley, MD, of The Ohio State University, is the corresponding author for the JAMA article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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