Association Between Availability of Molecular Genotyping Results and Overall Survival in Patients With Advanced Nonsquamous Non–Small-Cell Lung Cancer

Abstract

PURPOSE Current guidelines recommend molecular genotyping for patients newly diagnosed with metastatic nonsquamous (mNSq) non–small-cell lung cancer (NSCLC). The association between availability of molecular genotyping before first line (1L) therapy and overall survival (OS) is not known. METHODS We conducted a real-world cohort study using electronic health records in patients newly diagnosed with mNSq NSCLC. Cox proportional-hazards multivariable regression models were constructed to examine the association between OS and test result availability before 1L therapy, adjusting for covariates. Additional analyses were conducted to assess the consistency and strength of the relationship. Multivariable logistic regression models were used to examine the association between concurrent tissue and plasma testing ( v tissue alone) and result availability. RESULTS Three hundred twenty-six patients were included, 80% (261/326) with results available before 1L (available testing group), and 20% (65/326) without results available (unavailable testing group). With 14.2-month median follow-up, patients in the available testing group had significantly longer OS relative to the unavailable testing group (adjusted hazard ratio, 0.43; 95% CI, 0.30 to 0.62; P < .0001). The adjusted odds of availability of results before 1L therapy was higher with concurrent tissue and plasma testing ( v tissue testing alone; adjusted odds ratio, 2.06; 95% CI, 1.09 to 3.90; P = .026). CONCLUSION Among patients with mNSq NSCLC in a real-world cohort, availability of molecular genotyping results before 1L therapy was associated with significantly better OS. Concurrent tissue and plasma testing was associated with a higher odds of availability of results before 1L therapy. These findings warrant renewed attention to the completion of molecular genotyping before 1L therapy.

Barriers and Unequal Access to Timely Molecular Testing Results: Addressing the Inequities in Cancer Care Delays across Canada

“…Molecular testing enables accurate identification of a specific tumor profile that indicates that a patient may be a candidate for targeted treatments that are more effective and less toxic. For patients, timely access to molecular testing leads to optimized personalized care that results in improved health outcomes, including clinical, quality of life, and survivorship outcomes [ 6 , 7 ], and by extension lower healthcare costs [ 8 ]. For clinicians, biomarker testing helps to predict and monitor response to therapies, increasing clinicians’ ability to prescribe or alter therapy at the right time for a patient to maximize treatment effectiveness, spare unnecessary treatments, and save healthcare resources [ 9 ].…”

Targeted therapeutic options in early and metastatic NSCLC-overview

“…Patients with guideline-recommended molecular alteration-based therapies have better outcomes with first-line targeted therapy for advanced-stage NSCLC [ 1 ]. In a retrospective study, others showed a significant increase in OS in patients with non-squamous NSCLC with molecular testing available compared to non-tested patients [ 122 ]. Importantly, comprehensive NGS vs. incomplete or no testing before initiating first-line therapy impacts the OS (22.1 vs. 11.6 months, p = 0.017) respectively [ 123 ].…”

European Real-World Assessment of the Clinical Validity of a CE-IVD Panel for Ultra-Fast Next-Generation Sequencing in Solid Tumors

“…Long TATs are often not compatible with the clinical conditions of cancer patients who might be referred to generic chemotherapy in the absence of biomarker information in clinically meaningful time frames. The implications stemming from extended TATs have been thoroughly examined in a pair of recent studies [ 19 , 20 ]. These investigations have delved into the effects of long TATs, particularly within the context of patients diagnosed with NSCLC.…”