Genomic Profiling of Advanced Non–Small Cell Lung Cancer in Community Settings: Gaps and Opportunities

TY - JOUR

T1 - Genomic Profiling of Advanced Non–Small Cell Lung Cancer in Community Settings

T2 - Gaps and Opportunities

AU - Gutierrez, Martin E.

AU - Choi, Kelly

AU - Lanman, Richard B.

AU - Licitra, Edward J.

AU - Skrzypczak, Stanley M.

AU - Pe Benito, Ruth

AU - Wu, Tommy

AU - Arunajadai, Srikesh

AU - Kaur, Sukhi

AU - Harper, Harry

AU - Pecora, Andrew L.

AU - Schultz, Eric V.

AU - Goldberg, Stuart L.

N1 - Publisher Copyright: © 2017 The Author(s)

PY - 2017/11

Y1 - 2017/11

N2 - The US and European guidelines have recommended testing of advanced non–small cell lung cancer (NSCLC) patients for multiple targetable genomic alterations. We found that roughly one third of 814 nonsquamous NSCLC patients in a large oncology practice had not been tested for EGFR or ALK, with more marked under genotyping of additional genomic targets. The challenges and potential solutions are discussed. Background National guidelines have advocated broad molecular profiling as a part of the standard diagnostic evaluation for advanced non–small cell lung cancer (NSCLC), with the goal of identifying driver mutations for which effective therapies or clinical trials are available. However, adherence to genomic testing guidelines could present challenges to community oncologists. Patients and Methods We performed a retrospective review of genomic testing patterns in patients with nonsquamous NSCLC treated by 89 oncologists at 15 sites throughout New Jersey and Maryland from January 2013 to December 2015. Results A total of 814 patients (89% with stage IV; 11% with stage IIIB) were identified in the COTA Inc database. Of the 814 patients, 479 (59%) met the guideline recommendations for EGFR (epidermal growth factor receptor) and ALK (anaplastic lymphoma kinase) biomarker testing; 63 (8%) underwent comprehensive genomic profiling for all 4 major types of alterations (point mutations, indels, fusions, and copy number amplifications). Gender, age, race, site of care (referral vs. community center), and practice size did not influence comprehensive genomic profiling frequency. Active smokers and patients who died within 30 days were tested less frequently (P <.05). Among those not tested for EGFR and ALK, 52% received chemotherapy without documented reasons for no testing, 32% did not receive antineoplastic therapy, and 13% had insufficient tissue for genotyping. Conclusion Genomic testing presents multiple logistical challenges for the community-based oncologist, including coordination of sample handling, long turnaround times, test reimbursement, access to targeted therapies, insufficient tissue, and patient harm from the repeat biopsies necessary if the tissue sample is insufficient. Opportunities exist for improvement in guideline adherence, possibly through new technologies such as “liquid biopsies,” which obviates the need tissue biopsy samples in select settings.

AB - The US and European guidelines have recommended testing of advanced non–small cell lung cancer (NSCLC) patients for multiple targetable genomic alterations. We found that roughly one third of 814 nonsquamous NSCLC patients in a large oncology practice had not been tested for EGFR or ALK, with more marked under genotyping of additional genomic targets. The challenges and potential solutions are discussed. Background National guidelines have advocated broad molecular profiling as a part of the standard diagnostic evaluation for advanced non–small cell lung cancer (NSCLC), with the goal of identifying driver mutations for which effective therapies or clinical trials are available. However, adherence to genomic testing guidelines could present challenges to community oncologists. Patients and Methods We performed a retrospective review of genomic testing patterns in patients with nonsquamous NSCLC treated by 89 oncologists at 15 sites throughout New Jersey and Maryland from January 2013 to December 2015. Results A total of 814 patients (89% with stage IV; 11% with stage IIIB) were identified in the COTA Inc database. Of the 814 patients, 479 (59%) met the guideline recommendations for EGFR (epidermal growth factor receptor) and ALK (anaplastic lymphoma kinase) biomarker testing; 63 (8%) underwent comprehensive genomic profiling for all 4 major types of alterations (point mutations, indels, fusions, and copy number amplifications). Gender, age, race, site of care (referral vs. community center), and practice size did not influence comprehensive genomic profiling frequency. Active smokers and patients who died within 30 days were tested less frequently (P <.05). Among those not tested for EGFR and ALK, 52% received chemotherapy without documented reasons for no testing, 32% did not receive antineoplastic therapy, and 13% had insufficient tissue for genotyping. Conclusion Genomic testing presents multiple logistical challenges for the community-based oncologist, including coordination of sample handling, long turnaround times, test reimbursement, access to targeted therapies, insufficient tissue, and patient harm from the repeat biopsies necessary if the tissue sample is insufficient. Opportunities exist for improvement in guideline adherence, possibly through new technologies such as “liquid biopsies,” which obviates the need tissue biopsy samples in select settings.

KW - Matched therapy

KW - NSCLC

KW - Next-generation sequencing

KW - Targeted therapy

KW - Under genotyping

UR - https://www.scopus.com/pages/publications/85019001567

U2 - 10.1016/j.cllc.2017.04.004

DO - 10.1016/j.cllc.2017.04.004

M3 - Article

C2 - 28479369

SN - 1525-7304

VL - 18

SP - 651

EP - 659

JO - Clinical Lung Cancer

JF - Clinical Lung Cancer

IS - 6

ER -