Megahed on the Effects of NGS on First-Line Treatment Decisions in NSCLC

Ahmed Megahed, MBBCh, Southern California Permanente Medical Group, discusses the rationale for investigating the effects of next-generation sequencing (NGS) on first-line treatment decisions for patients with stage IV non–small cell lung cancer (NSCLC).

In 2019, Kaiser Permanente implemented a system in which NGS would be ordered for all patients within the Kaiser Permanente Southern California health care system diagnosed with metastatic or stage IV cancer, Megahed says. A cross-sectional study collected data from patients within this health care system who were diagnosed with stage IV NSCLC and completed NGS between May 2019 and June 2021. The aim of this study was to evaluate how NGS was being used for these patients and how NGS results affected first-line treatment decisions, which are typically more time-sensitive than treatment decisions in subsequent lines of therapy, Megahed explains.

This study stratified patients by whether they had initiated treatment before or after receiving their NGS results. Patients with alterations in ALK, EGFR, ROS1, KRAS, BRAF, MET, or RET were considered eligible for targeted first-line therapy.

The investigators found that NGS results did not exclusively inform first-line treatment decisions in this population. Of the 760 patients who had undergone NGS, 284 (37%) started treatment before their NGS results were reported, and 262 (34%) started treatment after receiving their NGS results. Additionally, 214 patients (28%) received no treatment for up to 120 days after their NGS results were reported.

NGS revealed a targetable mutation in 43% (n = 323) of the study population, 38% (n = 124) of which received frontline targeted therapy. Among those 124 patients, 45% (n = 56) received targeted therapy before their NGS results were reported, and 55% (n = 68) initiated targeted therapy after their NGS results were reported. In total, 61% (n = 118) of patients with EGFR, ALK, or ROS1 mutations received targeted therapy, and 67 patients with a driver mutation did not receive treatment and were referred to hospice.

Disclosures: Megahed has no relationships to disclose.