JTO Clinical and Research Reports (Apr 2022)

Plasma Genotyping at the Time of Diagnostic Tissue Biopsy Decreases Time-to-Treatment in Patients With Advanced NSCLC—Results From a Prospective Pilot Study

  • Jeffrey C. Thompson, MD, MTR,
  • Charu Aggarwal, MD, MPH,
  • Janeline Wong, BS,
  • Vivek Nimgaonkar, BS,
  • Wei-Ting Hwang, PhD,
  • Michelle Andronov, BS,
  • David M. Dibardino, MD,
  • Christoph T. Hutchinson, MD, MA,
  • Kevin C. Ma, MD,
  • Anthony Lanfranco, MD, MS,
  • Edmund Moon, MD,
  • Andrew R. Haas, MD, PhD,
  • Aditi P. Singh, MD,
  • Christine A. Ciunci, MD, MSCE,
  • Melina Marmarelis, MD, MSCE,
  • Christopher D’Avella, MD,
  • Justine V. Cohen, DO,
  • Joshua M. Bauml, MD,
  • Roger B. Cohen, MD,
  • Corey J. Langer, MD,
  • Anil Vachani, MD, MSCE,
  • Erica L. Carpenter, MBA, PhD

Journal volume & issue
Vol. 3, no. 4
p. 100301

Abstract

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Introduction: The availability of targeted therapies has transformed the management of advanced NSCLC; however, most patients do not undergo guideline-recommended tumor genotyping. The impact of plasma-based next-generation sequencing (NGS) performed simultaneously with diagnostic biopsy in suspected advanced NSCLC has largely been unexplored. Methods: We performed a prospective cohort study of patients with suspected advanced lung cancer on the basis of cross-sectional imaging results. Blood from the time of biopsy was sequenced using a commercially available 74-gene panel. The primary outcome measure was time to first-line systemic treatment compared with a retrospective cohort of consecutive patients with advanced NSCLC with reflex tissue NGS. Results: We analyzed the NGS results from 110 patients with newly diagnosed advanced NSCLC: cohorts 1 and 2 included 55 patients each and were well balanced regarding baseline demographics. In cohort 1, plasma NGS identified therapeutically informative driver mutations in 32 patients (58%) (13 KRAS [five KRAS G12C], 13 EGFR, two ERRB2, two MET, one BRAF, one RET). The NGS results were available before the first oncology visit in 85% of cohort 1 versus 9% in cohort 2 (p < 0.0001), with more cohort 1 patients receiving a guideline-concordant treatment recommendation at this visit (74% versus 46%, p = 0.005). Time-to-treatment was significantly shorter in cohort 1 compared with cohort 2 (12 versus 20 d, p = 0.003), with a shorter time-to-treatment in patients with specific driver mutations (10 versus 19 d, p = 0.001). Conclusions: Plasma-based NGS performed at the time of diagnostic biopsy in patients with suspected advanced NSCLC is associated with decreased time-to-treatment compared with usual care.

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