The impact of targeted therapies on overall survival in advanced malignancy.

Abstract

e15171 Background: Next-generation sequencing (NGS) analyzes DNA and RNA of malignant tumors through tissue or blood. NGS testing provides data about diagnosis, prognosis and treatment options. With the approval of tumor-agnostic drugs for targeted therapy, it is crucial to identify biomarkers that have precise targeted treatments. This retrospective study evaluates the overall survival (OS) data of patients in a community based cancer center with advanced solid tumors who received targeted therapy based on NGS results (Group 3) compared to patients with a targetable mutation identified but who were not treated with a targeted agent (Group 2) compared to patients who had no targetable mutation identified (Group 1). Methods: Patients with Stage 3 or 4 solid tumor malignancy diagnosed between January 1st, 2019-December 31st, 2022 were identified. 269 patients had NGS testing, 118 were excluded due to missing survival data. 151 patients were included in the study. NGS testing was performed on tissue (69.5%), liquid (27.2%) or both (3.3%). Patients were divided into 3 groups based on targetable biomarkers identified and therapy received. Results: The median age at diagnosis was 72 with 49% female. 67.6% had mutations identified and 37.8% had FDA approved indications. 37% of patients received targeted therapy. OS is displayed in table 1. The data shows that patients with a targetable mutation who were not treated with a targeted agent had the shortest OS at all time points. 83 patients had advanced lung cancer with 48% receiving targeted drugs. Those patients who were treated with precision medicine for an identified biomarker had increased OS. Interestingly, no statistically significant difference was seen between patients treated with precision medicine compared to patients with no targetable mutation and treated with standard therapeutic options. Conclusions: NGS testing has become standard in treating advanced solid tumor patients. This study reveals that patients treated with targeted therapy for identified mutations had the best OS. Those patients who did not receive targeted therapy, potentially due to lack of FDA approved drugs, cost or poor clinical performance status, had worse OS. This study highlights an urgent clinical unmet need of identifying novel biomarkers that are drivers of malignancy and developing therapies that target these biomarkers. Precision medicine leads to better OS. Future studies with larger, more ethnically diverse patient populations should be conducted to look at clinical outcomes and cost-effectiveness of NGS testing. Group 1: No Targetable Mutation(n=49) P-value between Group 1 & Group 2 Group 2: Targetable Mutation with No Targetable Treatment(n=45) P-value between Group 2 & Group 3 Group 3:Targetable Mutation with Targeted Treatment(n=57) P-value between Group 1 & Group 3 6 Month OS 91.8% 0.09 80% 0.002 98.3% 0.152 9 Month OS 85.7% 0.009 62.2% 0.003 87.7% 0.76 12 Month OS 81.6% 0.04 62.2% 0.04 84.2% 0.722