Genomic Profiling of Driver Gene Alterations in Patients With Non-Small Cell Lung Cancer, Patterns of Treatment and Impact on Survival Outcomes: A Single Center Experience of More Than 1200 Patients.

BACKGROUND

The utility of Next-Generation-Sequencing (NGS) in patients of non-small-cell-lung-cancer (NSCLC) has led to an exponential increase in the identification of driver-gene alterations, however, Indian NGS data was lacking.

MATERIALS AND

METHODS

This retrospective study conducted between May'2019 and Dec'2023 included histologically confirmed NSCLC cases with NGS testing done on tissue and/or liquid biopsy samples prior to treatment initiation. We reported the frequency of driver-gene alterations, clinicopathological profile, treatment patterns, and outcomes [Overall-Survival (OS)].

RESULTS

Data of 1230 patients was analyzed. Median age was 59 years (IQR,51-66), 65.3% (n = 803) were males, 34.6% (n = 426) had a history of smoking, and 78.1% (n = 961) had an adenocarcinoma histology. NCCN-recommended driver-gene alterations were seen in 64.8% (n = 797) cases. EGFR, ALK, ROS1, ERBB2, MET, RET, NTRK, BRAF and KRAS gene alterations were seen in 33.7% (n = 414), 7.6% (n = 94), 2.4% (n = 29), 6.1% (n = 75), 1.9% (n = 23), 2.2% (n = 22), 0.7% (n = 8), 3.3% (n = 40), and 9.6% (n = 118) cases respectively. 62.1% (n = 495/797) driver-positive patients could receive targeted therapy, and 21.7% (n = 94/433) driver-negative patients could receive immunotherapy. With the receipt of targeted therapy, median-OS of driver-positive patients was 26.7 months (95%CI, 23.3-32.7) versus 9.3 months (95%CI, 7.3-12.2, P < .001) without. Similarly, in driver-negative patients, median OS with the receipt of immunotherapy was 16.4months (95%CI, 14.7-24.4) versus 11.5 months (95%CI, 9.0-13.4, P = .006) without.

CONCLUSION

All eligible NSCLC patients must undergo molecular testing by appropriately chosen and cost-effective methods at diagnosis. Wherever possible, this should be done by NGS. Efforts should focus on improving access to targeted agents in India, and developing cost-effective alternatives.