Real-world EGFR, ALK, and PD-L1 testing performance and end-to-end intervals in Colombian patients with non–small cell lung cancer.

Abstract

11091 Background: Timely and comprehensive EGFR, ALK, and PD-L1 testing underpins effective precision oncology care in NSCLC, yet real-world data on testing completeness and integration into care pathways remain scarce in Latin America. Methods: We conducted a retrospective cohort study of adults with pathologically confirmed NSCLC treated at Fundación Santa Fe de Bogotá (2018–2025). EGFR/ALK/PD-L1 testing completeness, complete-panel availability, biomarker distributions, and turnaround times (order-to-report and diagnosis-to-report) were assessed. Stage III–IV sub analysis was performed. Results: A total of 242 patients were included. Most were female (53.3%), never-smokers (45.0%), and had adenocarcinoma histology (82.2%). EGFR, ALK, and PD-L1 results were available in 84.3%, 80.6%, and 80.6% of cases, respectively. Complete-panel availability was 74.4% and improved over time (adjusted OR per year, 1.28; 95% CI, 1.10–1.50; p=0.002). Turnaround times were favorable, with a median order-to-report time of 5 days (IQR, 2–8), and 68.0% completed within 7 days. The median diagnosis-to-report time was 12 days (IQR, 6–28.5), with 54.3% completed within 14 days. Activating EGFR mutations occurred in 38.7%, ALK fusions in 9.7%, and PD-L1 TPS ≥50% in 21.0%. In exploratory multivariable models, EGFR positivity was less frequent in ever-smokers (OR 0.26; 95% CI 0.13–0.51) and non-adenocarcinoma histology (OR 0.26; 95% CI 0.07–0.96). Guideline-concordant first-line targeted therapy was used in >80% of systemically treated patients with actionable alterations. In the stage III–IV subset (median age, 71.3 years; 53.8% female), median intervals were 13 days for imaging-to-diagnosis and 27 days for diagnosis-to-treatment (IQR, 16–52), with 33% exceeding 30 days and higher rates among patients referred after extra-institutional diagnosis. Median diagnosis-to-molecular report and report-to-treatment intervals were 11 days (IQR, 5–21) and 14 days, respectively. Requirement for EBUS was associated with longer imaging-to-diagnosis delays (75% >30 days; p=0.01). Conclusions: This study provides Latin American benchmarks for precision oncology delivery in NSCLC, showing high and improving molecular testing completeness with rapid turnaround. While molecular readiness was favorable, treatment initiation—especially for referred patients—represented the principal optimization gap. Standardized diagnosis-initiated testing and navigation workflows may improve end-to-end pathway performance. Temporal trends in biomarker testing completeness in NSCLC (2018–2025). Metric 2018–2020 (n=87) 2021–2023 (n=93) 2024–2025 (n=59) Overall (N=242) EGFR available, % 77.0 86.0 93.2 84.3 ALK available, % 73.6 80.6 91.5 80.6 PD-L1 available, % 71.3 83.9 89.8 80.6 Complete panel available, % 65.5 74.2 88.1 74.4