Background – ESMO and NCCN have recommended Comprehensive Genomic Profiling (CGP) to identify patients eligible for matched targeted treatment. Here, we assess adherence with guideline-recommended targeted therapy recommendations and assess the time from genomic sequencing to the initiation of targeted medication in a diverse, real-world dataset of advanced NSCLC patients.

Methods – We retrospectively analyzed de-identified metastatic NSCLC records from the Tempus multimodal database, which encompasses molecular and clinical data from diverse clinics across the United States sequenced with the Tempus xT assay from 2018-2022. The following guideline recommended actionable genomic variants were assessed: EGFR mutations, ALK fusions, ROS1 fusions, KRAS G12C mutations, BRAF V600E, RET fusions, MET ex14 skipping mutations, and NTRK1/2/3 fusions. Patients were defined as adherent if they received matched targeted therapy recommended in guidelines within 24 months of sequencing; genomic sequencing may have occurred prior to matched therapy recommendation.

Results – Among 1,407 evaluable patients, 16.5% (N= 232) had a targeted actionable variant detected by CGP. The overall adherence rate of matched targeted therapy was 87% (N=201). The adherence rate varied by actionable variant, with the highest adherence rate of 100% for EGFR exon 19 deletions (n=57), and the lowest rate 47% for BRAF V600E (n=17). Notably, a minority of adherent patients (13.4%, n=27) were sequenced prior to the FDA approval of these targeted agents and inclusion in guidelines. For these patients the median time from CGP to initiation of matched therapy was 10 months. For the remaining patients, this time was 0.6 months.

Conclusions – In a real-world, retrospective analysis of a cohort of advanced NSCLC patients, most oncologists utilized CGP to identify and treat patients with guideline-recommended variant matched targeted therapy, with adherence rates varying by variant. Importantly, even patients that received CGP results prior to FDA approval of novel therapies, received matched therapy once they were included in guidelines.

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