Patients diagnosed with advanced non-small cell lung cancer (NSCLC) demonstrate better clinical outcomes when treated with therapies that focus on specific genetic variants, as opposed to traditional chemotherapy. ESMO and NCCN have advocated for the use of comprehensive genomic profiling (CGP) to determine which patients qualify for matched targeted therapies. The assessment of adherence with the targeted therapy recommendations outlined in the guidelines and the analysis of the duration from genomic sequencing to the commencement of targeted treatment within a diverse, real-world data set of patients with advanced NSCLC was presented at ESMO 2024.
A retrospective analysis was performed on deidentified records of patients with metastatic NSCLC obtained from the Tempus multimodal database. This database contains molecular and clinical information from a variety of clinics across the United States, with samples sequenced using the Tempus xT assay during the period from 2018 to 2022. The analysis focused on the following actionable genomic variants as recommended by clinical guidelines: EGFR mutations, ALK fusions, ROS1 fusions, KRAS G12C mutations, BRAF V600E, RET fusions, MET exon 14 skipping mutations, and NTRK1/2/3 fusions. Patients were deemed adherent if they harbored a targetable variant and received a targeted therapy once the matched therapy was included in the guidelines; it should be noted that genomic sequencing might have taken place before the therapy recommendation.
Among the 1407 patients eligible for evaluation, 201 were found to have a targeted actionable variant as determined by CGP. The adherence rate for matched targeted therapy across the cohort was 86.3%. Adherence rates differed according to the specific actionable variant, with EGFR exon 19 deletions showing the highest adherence rate of 100%, while BRAF V600E had the lowest adherence rate at 47.0%.
In a retrospective analysis conducted in a real-world setting involving a cohort of patients with advanced NSCLC, it was observed that the majority of oncologists employed CGP to identify and administer guideline-recommended targeted therapies based on specific variants. The adherence rates to these guidelines varied depending on the particular variant. Notably, patients who obtained CGP results before the FDA approval of new therapies were still able to receive matched treatments once these therapies were incorporated into the clinical guidelines.
Source: Patel JD, Nadhamuni K, Mitra A, et al. Comprehensive genomic profiling provides patients access to novel matched therapies in a diverse real-world cohort of advanced lung cancer patients. Barcelona, Spain, & online: presented at ESMO Congress 2024; abstract 79P.