Waiting for Genomic Test Results to Start Treatment Can Improve OS in NSCLC

Starting treatment for advanced non-small cell lung cancer (NSCLC) before receiving genomic test results compromises patient outcomes, according to research published in JCO Oncology Practice.

Researchers found that overall survival (OS) and time to next treatment or death (TTNT) were better among patients who started treatment after genomic testing had identified any actionable oncogenic drivers.

For this study, researchers used real-world, deidentified data from 510 patients in the Integra Connect Database. The patients had newly diagnosed, stage IV NSCLC with mutations in EGFR, ALK, ROS1, BRAF, MET, RET, ERBB2, or NTRK.

The patients were divided into 3 groups. In the first group (n=379), patients started treatment after genomic test results were received and actionable oncogenic drivers were identified. In the second group (n=47), patients started treatment before receipt of genomic test results but switched to the appropriate targeted treatment within 35 days. In the third group (n=84), patients started treatment before receipt of test results and did not switch treatment within 35 days.

The median OS was significantly longer for patients who started treatment after receiving test results than for patients who started treatment before results were available and did not switch treatment within 35 days.

The median OS was 28.8 months for patients treated after the receipt of test results, 21.7 months for those who switched treatment within 35 days (hazard ratio [HR], 1.12; P =.59), and 15.3 months for those who did not switch treatment within 35 days (HR, 1.62; P =.003). 

The median TTNT was significantly longer for patients who started treatment after receiving test results than for both of the other patient groups. The median TTNT was 13 months for patients treated after the receipt of genomic test results, 5.5 months for those who switched treatment within 35 days (HR, 1.73; P =.002), and 6.4 months for those who did not switch treatment within 35 days (HR, 1.71; P =.0002).

“These outcomes imply that even if National Comprehensive Cancer Network (NCCN) Guidelines are followed with an initial cycle of chemotherapy while testing is pending, an inferior outcome may result,” the researchers wrote. “Ideally, physicians should wait for test results before making treatment decisions to ensure patients receive appropriate therapy as early as possible and to mitigate exposure to ineffective or inappropriate treatments.”

Disclosures: This research was supported by Thermo Fisher Scientific. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Cancer Therapy Advisor