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Genomic profiling of non-small cell lung cancer in the community setting.
Background: Genotyping in patients (pts) with advanced NSCLC may identify mutations (mut) amenable to targeted therapy (TT). We identified in a 2010-2014 community series a 60% testing rate for EGFR/ALK among stage IV pts (Gutierrez ASCO 2015; e19113). 2014 guidelines added 5 additional targets for testing. Methods: Retrospective review advanced non-squamous NSCLC treated by 89 community oncologists (16 sites) throughout NJ and MD (Jan 2013 – Dec 2015). Results: 634 pts with NSCLC (566 stage IV and 68 stage IIIB) in the COTA database (89% adenocarcinoma, 7% NOS, 3% large cell, 1% sarcomatoid); median age 68 yrs; 52% female. 477 pts (75%) underwent any genotyping. Testing rates for EGFR were 67% in 2013, 80% 2014 and 69% 2015 (similar pattern with other mut). In never/passive smokers EGFR testing rate was 84% (47% pos for mut); 70% former smokers tested (13% pos); current 64% tested (5% pos) (p < 0.001 testing by smoking). KRAS testing performed in 32% with 31% pos, but did not triage genotyping (97% KRAS pos pts were tested for EGFR). Comprehensive NGS testing was performed in 15%, with additional 18% undergoing limited genotyping beyond EGFR/ALK. Rates of comprehensive NGS increased (2013: 10%, 2015: 23%; p < 0.001). Similar rates of NGS testing were observed among oncologists caring for > 10 pts or < 10 pts (15% vs 16%). 31 pts (5%) underwent second biopsy to obtain tissue for genotyping. Insufficient tissue was cited by 8%, with other documentation for non-testing lacking. Actionable EGFR/ALK findings were identified in 107 pts (22% tested); 73% of these received TT; 6% started chemo prior to test results (median 26 days vs 22 days who received TT; p = 0.36); 10% no treatment (7% early deaths). Genotyping identified actionable mut in 17 pts (2.6% overall population); (9 MET Amp/ 88 tested, 2 BRAF/98 tested, 2 ERBB2/ 52 tested, 2 RET/ 82 tested, 1 ROS1/ 85 tested, 1 MET Exon 14/ 46 tested). Among these 17 pts only 1 received TT (herceptin). Conclusions: Genotyping for EGFR/ALK remain below guidelines; most patients are undergenotyped for all 7 treatable mut. NGS testing rates are slowly increasing, which may reduce insufficient tissue exclusions. We plan to explore whether non-invasive comprehensive genotyping with cell-free DNA NGS may increase utilization of TT.
Abstracts by Martin Gutierrez:
Analysis of clinical and research implications of expanding next-generation sequencing (NGS) libraries in the treatment options of gastrointestinal cancers in a large cancer center.Meeting: 2017 Gastrointestinal Cancers Symposium | Abstract No: 774
Genomic-directed therapy of gastrointestinal cancers by comprehensive genomic profile (CGP): Clinical and genomic characteristics at the John Theurer Cancer Center (JTCC).Meeting: 2017 Gastrointestinal Cancers Symposium | Abstract No: 803
Phase I study of nivolumab (nivo) + nab-paclitaxel (nab-P) ± gemcitabine (Gem) in solid tumors: Interim results from the pancreatic cancer (PC) cohorts.Meeting: 2017 Gastrointestinal Cancers Symposium | Abstract No: 412