Reflex precision oncology consultation to increase comprehensive genomic profiling rates in non-small cell lung cancer.

Abstract

e20657 Background: Targeted therapies have transformed the treatment landscape for advanced non-small-cell lung cancer (NSCLC). Comprehensive genomic profiling (CGP) at diagnosis is essential for identifying actionable biomarkers and initiating appropriate therapies. However, national CGP rates remain low (39.3–44%), highlighting workflow inefficiencies. Delays in CGP hinder treatment planning and timely integration of immunotherapy (IO) or targeted therapies per NCCN guidelines. Reflex pathology-driven CGP at diagnosis addresses these delays but risks overutilization in early-stage disease (Stage I/II). This study assesses the feasibility and effectiveness of our institution's Reflex Precision Oncology Consultation (RPOC)-driven CGP strategy to improve testing rates while minimizing unnecessary use. Methods: A retrospective chart review was conducted on patients diagnosed with lung cancer using electronic health records between January 1 and June 30, 2024, at Allegheny Health Network, a community-based Integrated Cancer Healthcare Network. The workflow began with a pathologic diagnosis, followed by an RPOC order by the pathologist or interventional pulmonary team. The precision oncology team reviewed cases for staging and treatment potential, ordering CGP as appropriate. Key outcomes included molecular testing rates, result turnaround times, and barriers to testing. Results: Of 102 patients receiving RPOC, 27% had stage I/II, 15% had stage III/IV and subsequently entered hospice or died, and 7% had non-NSCLC malignancies. These 50 patients were excluded from further testing and analysis. This avoided futile CGP testing and overutilization of resources in roughly half of the cases. Among the 52 eligible patients, 29 (56%) were stage IV and 23 (44%) were stage III at diagnosis. 97% of Stage IV (28) and 61% of Stage III (14) patients underwent CGP, surpassing the national average. Within the stage IV group, 22 patients (76%) received CGP results before treatment initiation and so did 7 patients (30%) in the stage III group. The most frequently cited barrier to successful testing was insufficient tissue (62%). Of the 52 patients undergoing CGP, 29% had Tier 1 actionable mutations. These included KRAS G12C (17%), BRAF V600E (4%), EGFR exon 19 deletion (6%), and MET exon 14 skipping (2%). The average turnaround time from CGP order to results was 23 days. Conclusions: This pilot study of the RPOC-driven CGP strategy improved testing rates, expedited turnaround times, and optimized alignment with NCCN guidelines. Streamlined care minimized unnecessary testing in Stage I/II cases thus reducing costs, while enabling timely integration of IO and targeted therapies. This efficient, guideline-compliant model enhances care quality and provides a foundation for broader adoption. Future research will assess long-term outcomes and cost-effectiveness compared to standard care.