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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Thursday, June 13, 2024
Comprehensive genomic profiling, if done in a timely manner, may help inform the best first-line treatments. An article published in JCO Precision Oncology highlighted the effects of closing the time gap in receiving comprehensive genomic profiling in patients with non–small cell lung cancer (NSCLC). Jeff Yorio, MD, of the Texas Oncology, Austin, and colleagues examined testing and first-line treatment patterns in patients with advanced NSCLC. Their findings revealed that timely receipt of genomic profiling increased matched targeted therapy use by 14%, and the patient benefit was extended to real-world time therapy discontinuation.
A total of 2,694 patients with NSCLC were included in this study. Data were pulled from the Flatiron Health Foundation Medicine Clinico-Genomic Database to estimate the association of timely profiling results with therapy selection and patient outcomes. Testing and first-line treatment patterns were examined after the approval of the immune checkpoint inhibitor pembrolizumab in combination with pemetrexed and carboplatin (May 2017). Genomic profiling experiments were performed on DNA that was extracted from collected tissue specimens, and PD-L1 expression was assessed using immunohistochemistry assays.
Findings revealed that timely genomic profiling increased matched targeted therapy use by 14% (17% with profiling vs 2.8% without). Precision immune checkpoint inhibitor use was increased by 14% (18% with profiling vs 3.9% without). Additionally, there was an estimated 31% decrease in immune checkpoint inhibitor use among ALK/EGFR/RET/ROS1–positive patients. This also led to an expected per-patient reduction in ineffective immunotherapy cost of $13,659.37 with use of timely genomic profiling to inform treatment selection. Further, patient benefit of timely genomic profiling extended to real-world time to therapy discontinuation (median time to therapy discontinuation: 3.9 vs 10 months (hazard ratio [HR] = 0.54, 95% confidence interval [CI] = 0.42–0.70; adjusted HR = 0.50, 95% CI = 0.38–0.67) in first-line driver-positive patients.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
