Performance of comprehensive genomic profiling (CGP) versus single gene testing (SGT) in guideline-recommended biomarker selection in non-small cell lung cancer (NSCLC).
Authors: Subbiah Vivek , Vasudevan Anupama , Roos Alison , Schnettler Erica , Sathyan Pratheesh , Aton Lindsay , Varughese Prateesh , Blanc Simon 
Published: June 2024

8640

Background: Professional NSCLC guidelines recommend broad molecular profiling with the goal of identifying actionable oncogenic drivers (AODs) for which targeted therapies are either approved or under investigation in clinical trials. Even though the rates of molecular testing have increased, the use of CGP is variable and SGT testing is still widely utilized. Prior studies have demonstrated that patients who receive treatment before the report of AODs have compromised outcomes; however, there are a paucity of studies that assess the correlation between modality of genomic testing and patient outcomes. Methods: This retrospective analysis of real-world data from the IntegraConnect – Precision Q deidentified database included patients ≥18 years with newly diagnosed stage IV NSCLC that had a somatic test reported (n=4,446) from January 1, 2018, to October 31, 2023. Patients who received biomarker testing for EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, ERBB2, and/or NTRKwere considered for analysis. The CGP cohort was defined as patients that received NGS testing for >50 genes, including liquid and tissue and RNA testing. Results: The median (IQR) age was 71 (64,78) years and 74.4% had a reported race of White. 59.3% and 24.8% were previous or current smokers, respectively. 83.9% of patients had non-squamous and 15.8% had squamous cell carcinoma. Of patients with all genomic testing details available (n=4,444), 3201 received CGP and 1243 had SGT. Test turnaround time, defined as date of test order to reporting of results, was a median of 10 (7,15) days for CGP testing versus 12 (6,17) days for SGT testing.71.1% of patients with CGP testing had all 9 biomarkers tested compared to 1.2% of patients with SGT testing. 74.1% of patients that received SGT had 4 or less biomarkers tested. The rates of EGFR and ALKtesting were similar, but ≤20% of patients with SGT received testing for RET, METand <10% for ERBB2, and NTRK compared to >79% receiving all biomarkers with CGP testing. Patients with CGP testing had shorter time to 1L treatment (median (IQR); 0.5 (0.2,0.) months) from diagnosis compared to patients with SGT (0.6 (0.3,1.0) months). Patient treatment and outcome data will be presented. Conclusions: In this real-world analysis, patients with stage IV NSCLC who underwent SGT received results for all 9 guideline recommended biomarkers only 1.2% of the time as compared to 71.7% of the time for patients tested with CGP testing. While testing rates for EGFR and ALK were comparable between the two groups, less than half of patients receiving SGT were being tested for KRAS, MET, RET, ERBB2, and NTRKbiomarkers. We conclude that SGT results in incomplete biomarker testing and compromises targeted therapy treatment for patients. Work is ongoing to better understand patient outcomes, including time to next treatment or death (TTNT) and overall survival (OS), in these two cohorts.