WCLC 2025 - Posters & ePosters-P1.17.66 Impact of Concurrent Tissue and Liquid Comprehensive Genomic Profiling (CGP) on Receipt of First-Line (1L) Therapy in a NSCLC

Pdf Summary

This study evaluates the impact of concurrent versus sequential tissue and liquid comprehensive genomic profiling (CGP) on first-line (1L) therapy selection and outcomes in advanced non-small cell lung cancer (aNSCLC). Utilizing the US-based Flatiron Health–Foundation Medicine clinico-genomic database, 2,740 patients diagnosed between September 2020 and September 2024 were analyzed for CGP testing patterns before initiating 1L treatment.

Key findings include:

1. <strong>Testing Paradigms and Driver Detection:</strong> Patients undergoing both tissue and liquid CGP, whether concurrently or sequentially, had higher driver mutation detection rates (62%) compared to tissue-only (52%) or liquid-only testing (48%). The distribution of actionable driver genes remained consistent across testing methods.

2. <strong>Therapy Selection:</strong> Concurrent testing led to a higher proportion of patients receiving 1L targeted therapies (24%) compared to sequential (22%), tissue-only (16%), or liquid-only (20%) testing. Among those with driver mutations, 78% of concurrent versus 73% of sequentially tested patients received targeted 1L therapies.

3. <strong>Time to Treatment:</strong> Concurrent testing was associated with a significantly shorter interval from CGP order to 1L therapy initiation compared to sequential and tissue-only testing. Notably, 76% of patients receiving concurrent testing began 1L treatment after both test results were available, versus 37% in the liquid-first sequential group.

4. <strong>Clinical Outcomes in EGFR Mutations:</strong> Among patients with EGFR L858R/exon 19 deletion mutations, concurrent testing correlated with significantly longer real-world overall survival (rwOS) and time to next treatment (rwTTNT), and a non-significant trend toward improved progression-free survival (rwPFS), relative to liquid-first sequential testing. These results accounted for confounding clinical factors via inverse probability of treatment weighting.

Patient demographics were broadly similar across cohorts, although those with concurrent or liquid-first sequential testing more frequently had stage IV disease, non-squamous histology, no smoking history, and bone/CNS metastases.

In conclusion, concurrent tissue and liquid CGP enhances driver mutation detection, expedites 1L therapy initiation, and is associated with improved outcomes in EGFR-driven aNSCLC. The authors suggest further research to understand the clinical impact of CGP testing paradigms.

Asset Subtitle

Jonathan Riess

Meta Tag

Speaker Jonathan Riess

Topic Global Health, Health Services, and Health Economics

Keywords

advanced non-small cell lung cancer

comprehensive genomic profiling

tissue and liquid biopsy

driver mutation detection

first-line therapy selection

targeted therapies

concurrent testing

sequential testing

EGFR mutations

real-world overall survival