Initiating treatment after molecular testing may improve outcomes for advanced NSCLC
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Key takeaways:
- Patients receiving a tyrosine kinase inhibitor after stage IV NSCLC diagnosis experienced extended OS.
- Receiving biomarker test results before initiating treatment may help improve outcomes.
CHICAGO — Patients diagnosed with stage IV non-small cell lung cancer who received a tyrosine kinase inhibitor following clinical molecular testing had better OS, according to research presented at ASCO Annual Meeting.
“The treatment of stage IV non-small cell lung cancer has transformed with the identification of oncogenic driver mutations and the development of targeted treatments,” Jeffrey A. Scott, MD, president and chief medical officer of Integra Oncology, said during a presentation.
“There are published guidelines that recommend clinical molecular testing of patients with advanced non-small cell lung cancer for therapy decisions,” he added. “In this study, we investigated the testing and treatment patterns in patients with stage IV non-small cell lung cancer treated in the real-world settings.”
Scott and colleagues conducted a retrospective observational study of patients diagnosed with stage IV lung cancer who were included in the Integra Connect PrecisionQ database and who tested positive for EGFR, ALK, ROS1, BRAF, MET, RET, HER2 or NTRK mutations, received treatment from January 2018 through December 2021 and had follow-up data available through May 2022.
A total of 5,195 patients were included in the study, of whom 3,532 initiated first-line therapy and 2,899 had somatic molecular testing ordered following diagnosis.
Among patients who had testing ordered, 30% received tissue-based next-generation sequencing, 26% had plasma-based next-generation sequencing, and 44% underwent testing with non-next-generation sequencing methods.
The researchers found that of the 934 patients who tested positive for a driver mutation, 72% had their test results available before they initiated treatment.
Scott and colleagues determined that among patients who received treatment after their biomarker results were available, 61% received a tyrosine kinase inhibitor (TKI) as initial treatment, 6% received chemotherapy, 23% received chemotherapy plus immuno-oncology, and 65% received immuno-oncology.
The researchers found that among patients initially treated with a TKI, the median OS was 24.46 months (95% CI, 21.9-29.18), and was 14.2 months (95% CI, 11.6-16.5) among those who were treated without a TKI (unadjusted HR = 1.56; 95% CI, 1.26-1.92).
“This was subject to inherent limitations of retrospective observational real-world evidence studies, but it strongly suggests that outcomes may be improved for patients who receive somatic testing and appropriate treatment according to clinical practice guideline,” Scott said. “Ultrafast [next-generation sequencing] or liquid biopsy for oncogenic drivers tested to minimize turnaround time should be applied to avoid treatment before mutation report.”
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Scott JA, et al. Abstract 9030. Presented at: ASCO Annual Meeting 2023; June 2-6, 2023; Chicago.
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