Abstract 864: Changes over time in real-world next-generation sequencing (NGS) test use in patients (pts) with advanced non-small cell lung cancer (aNSCLC)
Authors: Swaminathan Akshay , Stergiopoulos Stella , Snider Jeremy , Fisher Virginia , Castellanos Emily , Snow Tamara , Cho-Phan Cheryl , Comment Leah , Cunningham Rachel , McCusker Margaret E. 
Published: July 2021

Background: Four-fold growth in the past decade of actionable molecular targets for aNSCLC makes comprehensive assessment of pts' alteration status increasingly important. NGS can concurrently detect multiple genomic alterations and provides key insights to guide therapy selection. This study examined real-world NGS testing patterns and characteristics of pts with aNSCLC over time using three real-world databases (DB).

Methods: Pts diagnosed (dxed) with stage IIIB/C or IV NSCLC were selected from 1) Flatiron Health (FH) nationwide (US-based) de-identified EHR-derived clinical DB (FHDB); 2) FH-Foundation Medicine (FMI) clinico-genomic DB (CGDB), which includes FH clinical data linked to genomic data for pts tested by FMI, 3) Surveillance, Epidemiology and End-Results (SEER) US population-based cancer registry. Baseline characteristics were compared for pts included in each DB diagnosed in 2012-13, 2014-15 and 2016-17. Additional features and NGS test use were compared for pts in CGDB vs FHDB dxed in 2018-19. Changes in NGS test use over time were evaluated with Chi-squared tests for trend.

Results: Percent of NGS-tested pts in FHDB increased from 5% (366/7768) in 2012-2013 to 35% (3460/9759) in 2018-2019 (p&lt;0.001). In pts who were NGS-tested and had documented first-line (1L) therapy, % of pts tested around 1L start increased from 13% (32/253) and 26% (89/343) in 2012-13 to 76% (1488/1958) (p&lt;0.001) and 82% (2354/2873) (p&lt;0.001) in 2018-19 for CGDB and FHDB, respectively. Differences in characteristics of NGS-tested pts (CGDB) vs overall aNSCLC populations (FHDB and SEER) decreased over time (Table).

Conclusions: NGS testing increased markedly and moved earlier in the treatment course over time, aligned with the growth in molecular targets. These findings show that pts who are NGS-tested have become more reflective of the general aNSCLC population, and suggest that real-world NGS use largely captures the aNSCLC genomic landscape.

Table. Pt characteristics over time in NGS-tested (CGDB) vs overall aNSCLC populations (FHDB, SEER)CharacteristicaNSCLC Diagnosis Year2012-132014-152016-172018-19Number of Pts289107817842327CGDB289107817842327FHDB77689989103319759SEER378123781036874n/a*65 yrs or older at aNSCLC diagnosisCGDB42%53%60%64%FHDB64%64%66%67%SEER61%62%64%n/a*FemaleCGDB53%51%49%48%FHDB46%46%46%46%SEER44%45%46%n/a*Non-squamous cell histologyCGDB81%82%77%75%FHDB70%72%71%71%SEER66%69%69%n/aCommunity-based practiceCGDB89%94%93%93%FHDB92%91%91%90%History of SmokingCGDB72%79%80%84%FHDB86%86%86%87%*SEER data are available only through 2017, and do not include information on practice setting or smoking history

Citation Format: Akshay Swaminathan, Stella Stergiopoulos, Jeremy Snider, Virginia Fisher, Emily Castellanos, Tamara Snow, Cheryl Cho-Phan, Leah Comment, Rachel Cunningham, Margaret E. McCusker. Changes over time in real-world next-generation sequencing (NGS) test use in patients (pts) with advanced non-small cell lung cancer (aNSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 864.