Background

The study serves to determine how next-generation sequencing (NGS) affects overall survivorship for lung cancer patients in three separate clinical settings. Targeted therapies demonstrate significant improvement in clinical outcomes1–6 and now represent over 90% of the total oncology development pipeline.7

Methods

The study was conducted on historical data with lung cancer patients diagnosed and seen in one of our community oncology clinics between 4/10/2022 and 3/20/2023. Clinical and social health data were collected and abstracted from patient medical history (Doctor’s notes, Pathology studies, NGS results).

The data were compiled into a database containing the data features for each patient (Table 1).

Table 1.Data Features
Demographic Disease Identification Staging and Histology Care/Treatment Metrics
Date of Birth, Age, Gender, Ethnicity, Race, Smoking Status, Geographic Location Diagnosis Date, Type of Diagnosis (“Primary” or “Secondary”), ICD10 Diagnosis Code, ICD10 Diagnosis Code for Secondary Sites Histology, Stage at Diagnosis, T, N, M, Location of Secondary Sites Surgical Resection, Clinical Trial Candidacy, Current Treatment Regimen, Current Status, Last Status Date, ECOG Performance Score Overall Survivorship, NGS testing status, Primary Mutations Identified*, Other Clinically Significant Mutations

*EGFR, P53, ALK, ROS, KRAS, RET, MET, ERBB2, NTRK

Patients with incomplete data were excluded from the study, resulting in a population of n = 145.

Results

The study included 145 patients diagnosed from 09.12.2009 to 03.31.2023. The median age was 72 years, with ages ranging from 49 – 96. The population included 76 females and 69 males. 85% of patients were identified as smokers (123 smokers, 21 non-smokers, 1 unknown). A median ECOG of 1 indicates high patient quality of life. 40% (58) of patients were surgical candidates. 61.9% (65) of late-stage (≥IIB) patients received NGS testing and 15% (10) are receiving targeted therapy based on the results. Population RECIST statuses are as follows:

Table 2.
CR
Complete Response		 MR
Mixed Response		 PD
Progressive Disease		 PR
Partial Response		 SD
Stable Disease		 UK
Unknown/Deceased
56 (34%) 3 (2%) 17 (10%) 12 (73%) 42 (25%) 15 (9%)
Figure 1
Figure 1.No statistically significant differences seen in NGS on survival
Figure 2
Figure 2.LAF – Rural, DMC & NOA – Urban

Conclusion

Although NGS and the targeted therapies that follow are the next horizon for cancer treatment, in this relatively small population, with few actionable mutations, the results of our real-world dataset indicate no apparent overall survivorship advantages were conferred. Moreover, NGS testing percentages were highest at the rural clinic, not the urban clinics, elucidating testing patterns that contradict contemporary assumptions.

Moving forward, further studies should include other cancers and larger populations to further assess the obtained results.