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Utilization of Multigene Assays in Patients with NSCLC

Conference Correspondent

The practice of precision medicine using next-generation sequencing (NGS) to detect actionable genetic alterations has led to improved survival in advanced non–small-cell lung cancer (NSCLC); however, the long turnaround time of NGS testing results poses a limitation, underscoring the need for rapid multigene testing alternatives.

LC-SCRUM-Asia is a lung cancer genomic screening project that collected genomic information and clinical outcomes. In the first phase of LC-SCRUM-Asia (February 2013 to March 2015), a single-gene assay targeting ALK/ROS1/RET genes was used for genomic screening, while a targeted NGS assay (Oncomine Comprehensive Assay [OCA]) was used in the second phase (April 2015 to May 2019). In the third phase (June 2019 to February 2021), 2 rapid multigene tests were used, a multigene PCR assay (Amoy 9-in-1 test) and a rapid NGS assay (Genexus/Oncomine Precision Assay [OPA]).

The LC-SCRUM-Asia project enrolled a total of 11,075 Japanese patients with NSCLC; of these, 1536 were enrolled in the first phase, 5416 in the second phase, and 4123 in the third phase. The median turnaround time was shorter for the Amoy 9-in-1 test (3 days) and for Genexus/OPA (4 days) compared with OCA (18 days).

The frequencies of genetic alterations (EGFR/KRAS/HER2/BRAF/MET/ALK/ROS1/RET) detected in the second and third phases were similar. Based on the identified genetic alterations, a significantly higher proportion of patients received first-line targeted therapy in the third phase compared with the second phase (34% vs 16%); a higher proportion of patients were enrolled in genotype-matched clinical trials in the third phase compared with the first phase (6.3% vs 3.1%; P <.001) and second phase (6.3% vs 2.6%; P <.001). Among patients who received first-line therapies, the median progression-free survival was significantly longer in the third phase compared with the second phase (8.5 months vs 6.1 months; P <.001).

Results of this study indicate that the utilization of rapid NGS tests such as the Amoy 9-in-1 test and the Genexus/OPA test in the LC-SCRUM-Asia project was associated with short turnaround times (3-4 days) compared with a targeted NGS assay, resulting in a higher proportion of patients receiving first-line targeted therapies or enrollment in matched clinical trials.

Source: Matsumoto S, et al. J Clin Oncol. 2021;39(suppl 15):Abstract 9094.

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