Next-generation sequencing in non-small cell lung cancer management in Lebanon: Clinical practices and barriers to implementation.

Abstract

e20692 Background: Next-generation sequencing (NGS) is a cornerstone of precision oncology; it enables comprehensive genomic profiling and allows for the identification of actionable mutations to guide treatment. International guidelines recommend NGS before initiating therapy in advanced non-small cell lung cancer (NSCLC). However, real-world NGS implementation remains inconsistent, particularly in low and middle-income countries. In Lebanon, data on NGS utilization and barriers to integration in lung cancer are limited. Methods: We conducted a cross-sectional descriptive study in Lebanon using a 25-item, self-administered online questionnaire distributed to licensed pulmonologists, radiation oncologists, and hematologist-oncologists through national professional societies. Data were analyzed using IBM SPSS statistics. Results: 33 clinicians responded, of whom 67% were males. Most respondents were medical oncologists (58%), followed by pulmonologists (12%) and radiation oncologists (9%), with 49% having > 20 years of clinical practice. 45% of the participants worked in academic hospitals, while 55% practiced in community settings, and most managed 10 lung cancer patients per month (67%). Overall, 84% reported familiarity with NGS testing. NGS use was reported by 65.2% of clinicians for nonsquamous metastatic NSCLC (mNSCLC) (95% CI: 44.2-86.3%) and 36.4% for squamous mNSCLC (95% CI: 14.5-58.2%). NGS was most frequently ordered at initial diagnosis (60%), followed by after first-line therapy failure (24%). Tissue-based NGS was used by 76% of clinicians, while 38% of academic clinicians reported routinely ordering both tissue and liquid biopsy; no respondents used liquid biopsy alone. Tumor molecular profiling was most performed through third-party laboratories (64%), with fewer clinicians reporting access to both in-house and external testing (20%). The reported turnaround time was most frequently between 1-2 weeks (33%) or 2-3 weeks (38%), while 21% reported turnaround times exceeding 3 weeks. Among clinicians who did not routinely order NGS for nonsquamous mNSCLC, single gene testing was common, with testing for EGFR mutations (100%), ALK rearrangement (91%), ROS1 rearrangement (73%), and less frequently BRAF, KRAS, and MET. The reported benefits of NGS included identification of actionable mutations (68%) and personalized treatment options (86%), while cost or lack of insurance coverage (91%) and tissue sample inadequacy (41%) were the predominant barriers. Conclusions: This study addresses a critical regional knowledge gap by estimating real-world NGS use in mNSCLC care in Lebanon, revealing variable adoption despite high perceived clinical value. Financial and tissue-related barriers remain key limitations, underscoring the need for policy and institutional support to advance precision oncology in the region.