Clinical Lung Cancer

Genomic Profiling of Advanced Non–Small Cell Lung Cancer in Community Settings: Gaps and Opportunities.

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This retrospective review of genomic testing patterns in patients with non-squamous NSCLC, treated by 89 oncologists at 15 sites, showed that genomic testing presents multiple logistical challenges for the community-based oncologist. Liquid biopsies can possibly obviate the need for tissue biopsy samples in select settings.

Nov 2017


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Liquid biopsy could help rescue patients who cannot receive genotype testing because of insufficient tissue.”

Martin E. Gutierrez, MD
John Theurer Cancer Center

Key Findings26

  • The demands on tissue specimens from diagnostic stains and PD-L1 testing may leave little remaining for genomic profiling
  • Gaps in genomic biomarker testing can be overcome with new technologies

Clinical Summary

Genotyping rates for NCCN-genomic targets in advanced NSCLC. This prospective study demonstrated the clinical utility of using ctDNA to guide treatment selection in advanced cancer patients. A quarter of patients in the NSCLC cohort were matched to targeted therapy.

Overall survival stratified by therapy type. Median overall survival more than doubled (31.8 vs. 12.7 months) with targeted therapy, compared to non-targeted cytotoxic therapy.

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Key Findings19

  • Guardant360 detects guideline-complete alterations in advanced NSCLC patients, including MET exon 14 skipping alterations
  • ORR and DCR equivalent in Guardant360 and tissue biopsy groups in the VISION trial MET exon 14 skipping NSCLC cohort

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Key Findings24

  • Concordance between Guardant360 and tissue testing was greater than 90% for the four biomarkers with FDA-approved therapies
  • Guideline-recommended biomarker testing was completed for 95% of patients with Guardant360 vs. 31% with standard-of-care tissue testing
  • Turnaround time was ~1 week faster with Guardant360 vs. SOC tissue testing

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Key Findings25

  • 44% of eligible patients were unable to get complete genomic results from tissue biopsy
  • 2x as many patients had targetable alterations detected by Guardant360 and tissue testing (n=82) versus tissue testing alone (n=47)
  • 86% of patients had a response or stable disease based on RECIST criteria

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Key Findings

  • In the NSCLC cohort, 32.2% (19 patients) had a confirmed objective response (complete or partial response) and 88.1% (52 patients) had disease control (objective response or stable disease).
  • The median progression-free survival was 6.3 months.

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Key Findings26

  • The demands on tissue specimens from diagnostic stains and PD-L1 testing may leave little remaining for genomic profiling
  • Gaps in genomic biomarker testing can be overcome with new technologies

Learn More

Key Findings27

  • Comprehensive ctDNA testing can effectively guide therapy selection
  • Response rates to therapy selected based on Guardant360 results were consistent with those in tissue-based targeted therapy studies

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