Patients with non–small cell lung cancer (NSCLC) who received broad-based genomic sequencing in the first-line setting showed improved survival outcomes compared with patients who received testing in the second-line setting or who received focused biomarker testing, according to study findings published in JNCCN—Journal of the National Comprehensive Cancer Network.
“Our findings and prior work suggest broad-based genomic testing should be the default for patients with advanced lung cancer and should ideally happen prior to the administration of first-line therapy,” stated co-senior author Ravi B. Parikh, MD, MPP, Emory University School of Medicine. “The right test, done early, can open doors to treatments that might otherwise be missed.”
Background and Study Methods
The NCCN Clinical Practice Guidelines in Oncology® for NSCLC recommend the use of broad-based genomic sequencing for patients in advanced or metastatic stages.
Researchers sought to quantify the impact of early broad-based genomic sequencing on survival. They conducted a retrospective cohort study using electronic health record data from the Flatiron Health Research Database. The database covers the years 2016 to 2022 and includes data from about 280 U.S. academic and community oncology clinics.
The researchers gathered data for adults with stage IIIB to IV NSCLC who had received at least one line of systemic therapy. Patients were categorized by whether they had received broad or focused testing less than 3 months prior to starting first- or second-line therapy.
The primary outcome was progression-free survival, and the secondary outcomes was overall survival.
Key Findings
A total of 20,016 patients were included in the matched first-line analysis. Patients who received broad-based genomic testing had a median progression-free survival of 6.4 months compared with 6.0 months with focused biomarker testing (adjusted hazard ratio [aHR] = 0.96; P = .046). The median overall survival was 16 months with broad vs 14 months with targeted testing (aHR = 0.91; P < .001).
Higher biomarker positivity was found in patients who underwent broad-based testing (60% vs 22%) and higher rates of targeted therapy use (19% vs 16%).
“While it may seem obvious that broad genomic sequencing of tumors leads to the use of more targeted therapies and ultimately better outcomes compared to focused biomarker testing, this can be difficult to prove without large numbers of patients from multiple different health systems over long periods of time,” noted Heather Hampel, MS, CGC, Associate Director, Division of Clinical Cancer Genomics, City of Hope, who was not involved with this research. “This study is helpful because it utilizes electronic health data to show that broad-based genomic sequencing was associated with improved survival in patients with advanced [NSCLC] and leads to higher biomarker directed targeted therapy use in the matched first-line analysis compared to focused biomarker testing. This also avoids use of other therapies that may be less effective or even harmful.”
In the matched second-line cohort (n = 15,044), broad-based testing was not associated with improved survival.
Dr. Parikh concluded: “Coverage should match the evidence; we need to make sure that access to that testing doesn't depend on insurance, provider, or location. And if you or someone you love is diagnosed with advanced lung cancer, ask your care team one question before treatment starts: ‘Has my tumor had comprehensive biomarker testing?’”
DISCLOSURES: For full disclosures of the study authors, visit jnccn.org.
