Next-Generation Sequencing Completion and Timeliness Using a Reflex Testing Protocol for Patients with Stage II to IV...

Area of Science:

• Oncology
• Genomics
• Clinical Pathology

Background:

• Next-generation sequencing (NGS) is crucial for guiding treatment in non-small cell lung cancer (NSCLC).
• A significant number of NSCLC patients do not receive timely or complete genomic testing.
• This study assesses NGS completion and timeliness in stage II-IV NSCLC at an academic institution using a reflex testing protocol.

Purpose of the Study:

• To evaluate the completion rates and timeliness of next-generation sequencing (NGS) testing.
• To assess the impact of NGS results timing on overall survival in stage IV non-small cell lung cancer (NSCLC).

Main Methods:

• Retrospective analysis of 501 patients with stage II-IV non-squamous NSCLC diagnosed between 2015-2022.
• Implementation of a reflex, tissue-based NGS testing protocol initiated in 2015, with pyrosequencing used for NGS failures.
• Evaluation of testing completion, turnaround time, and correlation with treatment initiation and survival.

Main Results:

• NGS was completed in 75.8% of patients; 92.8% had some form of tissue-based genomic testing.
• Median time from biopsy to NGS completion was 17.0 days.
• 61.0% of patients received NGS results before any initial treatment, and 88.4% before systemic therapy.
• In stage IV patients, NGS results before first treatment were associated with improved median overall survival (2.27 years vs. 1.08 years, P=.04).

Conclusions:

• An in-house reflex NGS protocol effectively increased genomic profiling rates in NSCLC patients.
• Completing NGS before first-line therapy in stage IV NSCLC is linked to enhanced survival outcomes.