Byline: Jeffrey A. Scott, MD, Chief Medical Officer, Integra Connect
Advances in genetic testing have made it possible to determine, at a molecular level, which treatment options will best target a specific form of cancer. Data suggests that applying precision medicine techniques in this way can improve survival rates as well as quality of life, especially for patients with late-stage diagnoses of aggressive cancers[1] such as stage 4 non-small cell lung cancer.
To date, uptake of universal genetic testing has been slow despite documented improved survivals. Research that Integra Connect will present at the American Society of Clinical Oncology (ASCO) Annual Meeting makes a clear case for broad early and rapidly reported genetic testing.
Our retrospective observational study, supported by Thermo Fisher Scientific, focused on 525 newly diagnosed stage 4 NSCLC patients with genetic mutations (or actionable oncogenic drivers, AOD). The study demonstrated the value of the Integra Connect database – which includes de-identified claims and clinical records for community-based oncology practices across the United States – as it relates to deriving actionable insights from real-world data (RWD) that hold the potential to vastly improve cancer patient outcomes.
More importantly, this retrospective observational study shows that for this population, genetic testing with rapid turnaround time is critical. Research has shown that up to 30% of patients die within three months of their initial diagnosis[2] – and this time is punctuated by a poor quality of life from symptoms such as loss of appetite, difficulty breathing, fatigue, and persistent coughing.[3] However, with proper testing leading to personalized treatment plans, I believe these patients may live longer, more productive, and less symptomatic lives following their cancer diagnosis.
The findings of our study indicate that rapid genetic testing is a critical step in determining the appropriate course of treatment for patients, based on their tumor’s specific genetic profile. While those patients who were initiated on non-targeted treatments but switched to the appropriate targeted agents within 35 days had median survival of 672 days compared to 435 days in those not switched within this time frame, the patients with targeted treatment from the outset had a survival exceeding 800 days with median survival still not reached at the conclusion of the study.
In addition, the results of our study emphasize the need for near-universal genetic testing to determine patients who harbor genetic mutations. Patients who have treatable, targetable mutations but who are never tested and thus mutations go unrecognized, or who are tested only after initial treatment is started, fall into the parameters of that group noted above with the poorest survival.
My colleague, Dr. Robert Smith, helped spearhead this study. When asked about the most notable takeaways from the findings, he shared the following:
“This study showcases the power and potential of RWD to help ensure clinicians have actionable insights at the point of care – insights that can fundamentally improve and extend the lives of patients facing cancer. With these findings in mind, clinicians can and should look to universally test the non-squamous NSCLC patient and test in a manner that turnaround time from test order to result is fewer than 14 days so they can ensure they’re offering the most effective, personalized treatment options for patients. With new agents, in the near future we may see the benefit of early testing of patients with squamous carcinomas.”
[1] Kato, S., Kim, K.H., Lim, H.J. et al. Real-world data from a molecular tumor board demonstrates improved outcomes with a precision N-of-One strategy. Nat Commun 11, 4965 (2020). https://doi.org/10.1038/s41467-020-18613-3
[2] Guo H et al. “How Long Have I Got?” in Stage IV NSCLC Patients With at Least 3 Months Up to 10 Years Survival, Accuracy of Long-, Intermediate-, and Short-Term Survival Prediction Is Not Good Enough to Answer This Question. Front. Oncol. 11:761042. https://doi.org/10.3389/fonc.2021.761042
[3] Polanski J et al. Quality of life of patients with lung cancer. Onco Targets Ther. 2016; 9: 1023–1028. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4778772/