Targeted therapy significantly prolongs survival in lung adenocarcinoma. Current diagnostic guidelines include only EGFR and ALK testing. Next-generation sequencing (NGS) reveals more actionable genomic alterations (GAs) than stan dard diagnostic methods. Data on the influence of hybrid capture-based (HC-based) NGS on treatment are limited, and we investigated its impact on treatment decisions/clinical outcomes.
This retrospective study included patients with advanced lung cancer on whom HC-based NGS was performed between 11/2011-10/2015. Demographic and clinico-pathologic characteristics, treatments, and outcome data were collected.
101 patients were included (median age, 63 years; 53% females; 45% never smokers; 85% with adenocarcinoma). HC-based NGS was performed upfront and after EGFR/ALK testing yielded negative or inconclusive results in 15% and 85% of patients, respectively. In 51.5%, HC-based NGS was performed before 1st-line therapy, and in 48.5%, after treatment failure. HC-based NGS identified clinically actionable GAs in 50%, most commonly in EGFR (18%), RET (9%), ALK (8%), MET (6%) and ERBB2 (5%). In 15 patients, it identified EGFR/ALK aberrations after negative prior standard testing. Treatment strategy was changed for 43 patients (42.6%). The overall response rate in these patients was 65% (complete, 14.7%; partial, 50%). Median survival was not reached. Immunotherapy was administered in 33 patients, mostly without an actionable driver, presenting disease control rate of 32% and an association to tumor mutation burden.
HC-based NGS influenced treatment decisions in close to half of the patients with lung adenocarcinoma and was associated with an overall response rate of 65%, which may translate into a survival benefit.
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weblog.maimonides.edu/farmacia/archives/UM_Informe_Autoevaluacion_FyB.pdf - //
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