Utilization and timeliness of next-generation sequencing testing for patients with resected or metastatic non-small cell lung cancer: A real-world analysis.

Abstract

11101 Background: Comprehensive next-generation sequencing (NGS) is an evidence-based molecular testing modality used to identify actionable oncogenic drivers in tumor tissue, guiding therapy selection and improving survival in early-stage and metastatic non-small cell lung cancer (NSCLC). However, uptake of NGS in oncology practices varies. This study aimed to identify hospital-level variation in NGS testing adoption within a statewide quality improvement collaborative. Methods: We conducted a cross-sectional analysis of patients with clinical Stage IB-IIIA NSCLC who underwent surgical resection and clinical Stage IV NSCLC sampled in 2023 across 10 academic, community, and integrated network hospitals in a statewide cancer quality improvement collaborative. Rates of NGS testing and turnaround times between biopsy date, NGS order date, NGS result date, and first treatment time were analyzed. Subsets of patients treated at facilities with in-house molecular labs or reflex molecular testing protocols were described. Multivariable logistic regression identified demographic and clinical predictors of NGS use. In a subset of patients with EGFR or ALK mutations, we evaluated tyrosine kinase inhibitor (TKI) use across hospital sites. Results: Among 318 patients, 34.9% had clinical Stage IB-IIIA and 65.1% had clinical Stage IV lung adenocarcinoma. NGS testing was performed in 65.1% of patients, with rates ranging from 13.5% to 97.8% across sites. Facilities with in-house NGS capabilities had higher NGS rates (87.8%) compared to facilities relying on send-out testing (50.8%). Similarly, facilities with reflex molecular testing protocols demonstrated higher NGS rates (75.4%) compared to those without reflex protocols (50.4%). Among patients with EGFR or ALK mutations, 77.8% received TKI therapy, with rates ranging from 0% to 100%. Of 113 early-stage patients, 32 (28.3%) had NGS performed pre-resection, 36 (34.0%) post-resection, and 40 (37.7%) did not have NGS performed. Across all sites, the median time from biopsy to NGS order was 29 days (IQR 20–49), from order to results was 13 days (IQR 11–18), and from biopsy to treatment initiation was 42 days (IQR 31–58). Smoking status was an independent predictor of NGS use with OR 0.28 (0.13-0.61, p=0.002). Conclusions: Significant variation exists in NGS adoption across hospital sites in a statewide quality improvement collaborative. However, turnaround times were consistent across sites. These benchmarking data, combined with qualitative insights, can inform quality improvement interventions for underperforming sites.