Genomic Profiling of Advanced Non–Small Cell Lung Cancer in Community Settings: Gaps and Opportunities

Abstract

The US and European guidelines have recommended testing of advanced non–small cell lung cancer (NSCLC) patients for multiple targetable genomic alterations. We found that roughly one third of 814 nonsquamous NSCLC patients in a large oncology practice had not been tested for EGFR or ALK, with more marked under genotyping of additional genomic targets. The challenges and potential solutions are discussed. Background National guidelines have advocated broad molecular profiling as a part of the standard diagnostic evaluation for advanced non–small cell lung cancer (NSCLC), with the goal of identifying driver mutations for which effective therapies or clinical trials are available. However, adherence to genomic testing guidelines could present challenges to community oncologists. Patients and Methods We performed a retrospective review of genomic testing patterns in patients with nonsquamous NSCLC treated by 89 oncologists at 15 sites throughout New Jersey and Maryland from January 2013 to December 2015. Results A total of 814 patients (89% with stage IV; 11% with stage IIIB) were identified in the COTA Inc database. Of the 814 patients, 479 (59%) met the guideline recommendations for EGFR (epidermal growth factor receptor) and ALK (anaplastic lymphoma kinase) biomarker testing; 63 (8%) underwent comprehensive genomic profiling for all 4 major types of alterations (point mutations, indels, fusions, and copy number amplifications). Gender, age, race, site of care (referral vs. community center), and practice size did not influence comprehensive genomic profiling frequency. Active smokers and patients who died within 30 days were tested less frequently (P