Utilization and timing of first tumor next-generation sequencing testing (NGS) in patients (pts) with five most common cancers in the USA.
Authors: Chadi Hage Chehade, Yeonjung Jo, Zeynep Irem Ozay, Micah Ostrowski, Nicolas Sayegh, Georges Gebrael, Richard Hardy, Edwin Lin, Richard Ji, Beverly Chigarira, Roberto H Nussenzveig, Ayana Srivastava, Vinay Mathew Thomas, Sumati Gupta, Benjamin L. Maughan, Neeraj Agarwal, Umang Swami
Journal: Journal of Clinical Oncology (2025)

11014 Background: In the USA, the 5 most common advanced/metastatic solid tumors are advanced non-small cell lung cancer (aNSCLC), metastatic breast cancer (mBC), metastatic prostate cancer (mPC), advanced colorectal cancer (aCRC), metastatic pancreatic cancer (mPanC). Life-prolonging targeted therapies are approved for pts with tumor-susceptible alterations, and guidelines recommend NGS to identify these alterations. Herein, we assessed the overall utilization of NGS and the timing of NGS in relation to the time of death in real-world pts with these cancers. Methods: This retrospective study utilized the nationwide Flatiron Health electronic health record (EHR) derived de-identified database. Eligibility: diagnosis of aNSCLC, mBC, mPC, aCRC, mPanC with information on receipt of NGS (blood/tissue) and recorded date of death. The time between each pt’s first NGS result and date of death was measured and pts were categorized into 3 groups: NGS results delivered &gt; 3 months (mo) before death, within 3 mo of death, and delivered/reported after death. Frequencies and percentages of the 3 categories were reported, also by the year of death and practice type. Results: Of 86,536 pts with aNSCLC, 31,375 received NGS (36.3%), of whom 19,958 had a date of death recorded. Of 36,000 pts with mBC, 11,550 were tested (32.1%), of whom 5,689 had a date of death recorded. Of 24,105 pts with mPC, 7,439 were tested (30.9%), of whom 3,397 had a date of death recorded. Of 35,702 pts with aCRC, 14,642 were tested (41%), of whom 8,553 had a recorded date of death. Of 14,964 pts with mPanC, 5,298 were tested (35.4%), of whom 3,957 had a recorded date of death. The timing of NGS relative to the time of death by cancer type is shown in Table. Across all cancers, the rate of pts receiving NGS results &gt; 3 mo before death increased over time, while the rate of those receiving results within 3 mo of death or after death decreased. Baseline characteristics (race-ethnicity, insurance plan, practice type) and NGS rates by year of death in the 3 categories will be presented in the meeting. Conclusions: Despite the availability of life-prolonging targeted therapies based on NGS results, a sizeable number of pts either do not undergo NGS or have their first NGS very late in the course of disease (i.e. within 3 mo of death). These results warrant better utilization of tumor NGS in a timely fashion in pts with cancer to optimize survival outcomes. Rates of first NGS relative to the time of death (in pts who underwent NGS and had a date of death recorded). Timing of first NGS results aNSCLCN = 19,958 mBCN = 5,689 mPCN = 3,397 aCRCN = 8,553 mPanCN = 3,957 &gt; 3 mo before death, n (%) 14,431 (72.3%) 4,643 (81.6%) 2,901 (85.4%) 7,271 (85%) 2,815 (71.1%) Within 3 mo of death, n (%) 5,109 (25.6%) 959 (16.9%) 457 (13.5%) 1,173 (13.7%) 1,047 (26.5%) After death (NGS result reported after death), n (%) 418 (2.1%) 87 (1.5%) 39 (1.1%) 109 (1.3%) 95 (2.4%)