Next-generation sequencing in patients with lung cancer undergoing immunotherapy: Retrospective analysis

Newswise — Background:Identifying targetable oncogenic drivers and resistance mechanisms by Next-generation sequencing (NGS) is critical in Non-Small Cell Lung Cancer (NSCLC).

Methods:We conducted a retrospective study at the University of Vermont Center to assess the utilization of NGS in NSCLC. We examined the medical records of NSCLC patients who received Immune Checkpoint Inhibitors (ICIs) as a first-line therapy between January 2017 and June 2022. We collected demographic data, including age, sex, ethnicity, cancer stage, NGS, mutations and survival data. Survival analysis was performed for the most common mutation by measuring the Hazard Ratio (HR) via Cox regression of different mutations compared to the whole cohort.

Results:We identified 95 NSCLC patients with 52.6% males, 94.7% whites and a mean age of 63.4 years (Standard Deviation (SD): 11.34). 67.4 % received Pembrolizumab and 30.5% got Durvalumab. Most patients had stage 4 and stage 3 cancers, with 54.7% and 35.8%, respectively. Mean ECOG of 0.9 (SD: 0.7), 34% had average body mass index, and overall mortality was 41%. PD L1 expression and NGS were reported in 81% of cases. NGS was reported in 88.5% of stage 4 and 76.5% of stage 3 categories. 41.8% had a type of KRAS mutation, with KRAS p.G12C being the most common. 24.1% of cases had no mutation. The mean survival months ranged from 7.6 months in MET to 52.4 months in RET mutation. Survival analysis showed decreased mortality in EGFR mutation, as seen in Table.

Conclusions:The rate of NGS testing at our rural academic center in Vermont is on the higher side of the national average NGS testing, but the turnaround time (TAT) of 28 days is suboptimal compared to NCI centers. Strategies to reduce TAT need to be implemented to get timely essential for tailoring therapies in patients with NSCLC. Further research is needed to explore the prognostic utility of mutations in NSCLC patients undergoing ICIs.