WCLC 2025 - Posters & ePosters-EP.06.54 The Landscape of Actionable Genomic Alterations in Non-Small Cell Lung Cancer. A Single Institution Quality Improvement Initiative

EP.06.54 The Landscape of Actionable Genomic Alterations in Non-Small Cell Lung Cancer. A Single Institution Quality Improvement Initiative

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This quality improvement (QI) initiative at a Canadian tertiary academic hospital analyzed two years (July 2021–June 2023) of in-house next-generation sequencing (NGS) testing using the Oncomine Comprehensive Assay version 3 (OCAv3) to identify actionable genomic alterations (AGAs) in non-small cell lung cancer (NSCLC). The study included 1,279 NSCLC patients across all stages, with a median age of 69 years, 42% male, and 90% having adenocarcinoma histology. Nearly half (48%) were stage 4 at testing.<br /><br />Molecular profiling revealed common mutations and fusions: KRAS mutations (37.9%), EGFR (13.5%), BRAF (5.6%), MET exon 14 skipping (2.5%), HER2 (1.5%), PIK3CA (2.7%), ALK fusion (1.9%), RET fusion (1.0%), and ROS1 fusion (0.6%). Rare single cases with NRG1, PTEN, and NTRK alterations were also observed. About 32.8% had no mutations detected. The rate of ALK and ROS1 fusions was noted to be slightly lower than previously published cohorts. PD-L1 testing was performed in 95.4% of cases, with 33.2% having high expression (≥50%), 27.8% intermediate (1–49%), and 34.2% negative (<1%).<br /><br />The study confirmed that the institution's NGS testing detected AGAs at anticipated frequencies, underscoring the importance of comprehensive genetic profiling in guiding targeted therapies in NSCLC. Future work will assess treatment patterns, including the use of targeted therapies and immunotherapy, co-mutation impacts, and survival outcomes. These findings will also aid in clinical trial planning. The study was conducted under ethics board exemption with strong institutional IT support. Overall, this initiative highlighted the feasibility and clinical relevance of routine comprehensive molecular profiling in NSCLC patient management at the center.

Asset Subtitle

Ahmed AL Lawati

Meta Tag

Speaker Ahmed AL Lawati

Topic Pathology and Biomarkers

Keywords

quality improvement

next-generation sequencing

Oncomine Comprehensive Assay v3

non-small cell lung cancer

actionable genomic alterations

molecular profiling

KRAS mutations

PD-L1 expression

targeted therapies

clinical trial planning