Real-World Adherence Patterns of Comprehensive Genomic Profiling to Biomarker Recommended Therapies in Patients With Advanced Non-Small Cell Lung Cancer.

Abstract

The National Comprehensive Cancer Network (NCCN) guidelines recommend comprehensive genomic profiling (CGP) for identifying advanced non-small cell lung cancer (NSCLC) patients eligible for targeted treatment, with frequent updates to incorporate new variant-targeted therapies. CGP panels can identify multiple actionable biomarkers from a single sample to match patients to targeted therapies. We assessed the adherence rate of NCCN recommendations to variant-specific matched therapy, the impact of timing of guideline updates on adherence rates, and time from sequencing to new targeted therapy adoption. We conducted a retrospective cohort study of stage IV NSCLC patients, with Tempus xT tissue-based sequencing. Adherence to NCCN-recommended therapy was defined as the proportion of patients who initiated guideline-directed targeted therapy when the presence of an actionable variant was identified. Among the 1,407 evaluable patients, 233 patients had a NCCN-recommended targetable variant. The treatment adherence rate was 86.3% (N = 201) with median time from sequencing to targeted therapy initiation of 23 days. A subset of adherent patients (13.4%, n = 27) had targetable variants identified prior to guideline recommendation for testing, but received matched targeted therapy within a median of 96 days of new guidelines recommendations. The variant-specific adherence rate was correlated with the timing of guideline recommendation (<i>P</i> = .02, Wald test), with lower adherence rates for variant-matched therapies recently included into guidelines. In a large, real-world cohort of advanced NSCLC patients tested with CGP, the treatment adherence rate to matched NCCN-recommended targeted therapy was high. This study highlights the importance of CGP testing in identifying variants to provide timely matched targeted therapy in a rapidly evolving biomarker and therapeutic landscape.