Benefits of Implementing Reflex Genomic Analysis for Nonsmall Cell Lung Cancer

Area of Science:

• Oncology
• Genomics
• Pathology

Background:

• Molecular biomarker analysis is crucial for advanced nonsmall cell lung cancer (NSCLC) treatment.
• Pathologist-driven reflex testing is a strategy to streamline this analysis.
• Our institution implemented a reflex testing protocol for advanced NSCLC after insourcing genomic analysis.

Purpose of the Study:

• To evaluate the impact of different genomic testing workflows on molecular testing efficiency.
• To compare time to initiation (IT), reporting time (RT), and test failure rates.
• To assess changes in test ordering practices and guideline-congruent testing.

Main Methods:

• Retrospective review of 578 NSCLC biopsies.
• Analysis of three workflows: send-out, in-house clinician-ordered, and in-house reflex testing.
• Assessment of IT, RT, test failure proportions, and ordering practices.

Main Results:

• Reflex testing demonstrated the lowest initiation time (0.95 weekdays) compared to send-out (30.0) and clinician-ordered (27.4).
• Test failure rates were highest for send-out (31.7%) versus in-house methods (10%).
• Guideline-congruent testing increased significantly with reflex implementation, reducing non-biomarker informed care.

Conclusions:

• In-house reflex genomic analysis for advanced NSCLC optimizes RT and significantly reduces IT and test failures.
• Insourcing genomic analysis and strategic care pathway design enhance access to molecular biomarker analysis.
• This approach mitigates non-biomarker informed cancer care in NSCLC.