Clinical Research Demonstrates Positive Impact of Genomic Testing for Patients with Non-Small Cell Lung Cancer

Melina Marmarelis

Cancer patients who receive molecular testing results prior to beginning first-line treatment for metastatic nonsquamous non-small cell lung cancer (NSCLC) appear to live longer, according to a study conducted by researchers at the University of Pennsylvania and published recently in JCO Precision Oncology.

The study was conducted through the utilization of electronic medical records from 326 adults, including patients of Florida Cancer Specialists & Research Institute (FCS), who were newly diagnosed with NSCLC between January 2019 and December 2020. Of these patients, 80 percent had the results of molecular testing performed on tissue or blood samples before starting treatment. The study concluded that patients who had testing results available prior to first-line treatment survived nearly four times longer than patients who did not. According to the published report, “Median overall survival among patients with available test results was 24.6 months compared to 6.2 months for those without results.”

Molecular testing can identify genetic mutations and biomarkers that help to determine certain targeted treatments deemed most effective in treating particular cancers.

Melina Marmarelis, a study author and assistant professor of medicine at the University of Pennsylvania, said, “The study was prompted because we know that molecularly informed treatment can improve survival; patients with a targetable alteration survive longer if they get a targeted therapy than if they get standard chemotherapy or immunotherapy.”

In 2021, FCS expanded its advanced genetic testing capabilities to include next-generation sequencing (NGS) which is becoming a standard technology for patients receiving treatment at the statewide practice’s nearly 100 community clinic locations.

“Genetic testing has been a game changer in the treatment of cancer and this latest study provides further confirmation of its true impact,” said Lucio Gordan, MD, FCS President & Managing Physician. “For our oncologists and clinical teams, NGS is the solution that enables us to treat a wide range of cancers with precision, enabling informed recommendations for personalized therapies and opening the door to clinical trial options based on each patient’s unique results.”

The study concluded that having the ability to prescribe targeted treatments based on genetic testing results often leads to better outcomes. Even patients in a progressive disease state who are not able to wait for results before starting a targeted treatment still fared better because the test findings provide beneficial insights into patient prognosis, leading to other lines of treatment. Among patients “without a therapeutically targetable mutation, those with pre-treatment test results had a median overall survival of 18.2 months versus 5.4 months for those without results,” according to the study.

Researchers sought to explore whether recommendations from the National Comprehensive Cancer Network (NCCN) related to molecular genotyping for NSCLC (1) would improve patient outcomes and also to help determine the best testing modalities.

NSCLC, one of the two main types of lung cancer, makes up about 85% of all lung cancer cases. Slow growing, it often metastasizes, spreading to other parts of the body, by the time it is diagnosed, making it more difficult to treat.

Additionally, while the research team emphasized the value of testing blood and tissues concurrently at diagnosis to speed up the process so that patients and oncologists receive results prior to treatment, cost and insurance coverage were cited as challenges. While Medicare has, since 2018, covered FDA-approved NGS panel tests for patients with advanced cancer, reimbursement by commercial payers is inconsistent. Efforts are underway in many states to advocate for broader coverage of biomarker testing. FCS currently holds 73% payer coverage for NGS testing and includes most insurances.

The study authors are continuing to explore additional benefits of molecular testing for metastatic NSCLC patients and expect their research will provide additional guidance to the oncology community. “FCS is proud to be part of ongoing research efforts that will ensure access combined with proper timing and delivery of targeted therapies that continues to bring hope to cancer patients. “

To access the full study results:

https://ascopubs.org/doi/full/10.1200/OP.22.00611

• The National Comprehensive Cancer Network (NCCN) recommends comprehensive molecular genotyping before first-line therapy for all newly diagnosed patients with metastatic nonsquamous NSCLC.