Real-world analysis of factors influencing turnaround time (TAT) for tissue comprehensive genomic profiling (CGP) in non-small cell lung cancer (NSCLC).

Abstract

11161 Background: CGP is an integral part of the standard of care for many solid tumor malignancies, and especially for NSCLC, as testing informs first-line treatment selection at most stages. CGP TAT is understudied but has implications for appropriate treatment delivery and patient outcomes. Methods: In this retrospective cohort analysis, TAT was calculated for U.S. tissue CGP testing orders received between January 2021 and September 2023 at a centralized commercial molecular laboratory (Foundation Medicine, Inc., Cambridge, MA, USA). Ordering TAT (specimen collection to CGP ordering), Specimen TAT (CGP ordering to specimen receipt at testing lab), Molecular TAT (specimen receipt to results reporting), and Overall TAT (specimen collection to results reporting) were calculated. Cases were excluded if CGP was ordered >6 months after specimen collection or if missing TAT data. Descriptive statistics and linear regression modeling for association of TAT with available clinical and molecular factors were performed. Results: A total of 40,728 NSCLC biopsies from 547 institutions were included in the analysis. The median Overall TAT for all samples was 29.8 days (IQR: 21.7, 44.6). Median times for Ordering TAT, Specimen TAT, and Molecular TAT were 14.8 days (IQR: 8.4, 27.8), 3.2 days (IQR: 1.3, 6.2), and 9.0 days (IQR: 7.7, 11.0), respectively. Aggregating and calculating TAT at the institution level, the median Overall TAT was 40.6 days (IQR: 38.5, 43.8) versus 21.9 days (IQR: 20.7, 23.7) among the slowest and fastest Overall TAT quintiles, respectively; Ordering TAT [median 15.1, IQR: 11.6, 18.9] and Specimen TAT [median 3.9, IQR: 1.9, 5.1] contributed to this variability, while Molecular TAT [median 9.0, IQR: 8.6, 9.3] remained consistent. Higher institutional order volume was the strongest predictor of shorter Overall TAT (-6.59 days [95% CI: -7.46, -5.71] for institutions with [100-200) vs <20 orders, P < .001), largely driven by variability in Ordering TAT (-4.13 days [95% CI: -4.95, -3.31] for institutions with [100-200) vs <20 orders, P < .001) and Specimen TAT (-2.25 days [95% CI: -2.47, -2.04] for institutions with [100-200) vs <20 orders, P < .001). Conclusions: This study demonstrates that NSCLC CGP TAT is highly variable and is influenced by institutional factors, particularly higher institutional ordering volume. For patients with an established diagnosis, the time between specimen collection/diagnosis and CGP ordering likely represents the longest and most modifiable component of Overall TAT. This study raises the hypothesis that adoption of coordinated interventions, such as reflex testing, could reduce Ordering TAT, and thus Overall TAT, for many patients.