Impact of Molecular Testing Using Next-Generation Sequencing in the Clinical Management of Patients with Non-Small Cell Lung Cancer in a Public Healthcare Hospital.

Autores de IIS La Fe

• Javier Simarro Farinos

  Autor

• Gema Pérez Simó

  Autor

• Nuria Mancheño Franch

  Autor

• Emilio Ansótegui Barrera

  Autor

• Carlos Muñoz Nuñez

  Autor

• José Gómez Codina

  Autor

• Óscar José Juan Vidal

  Autor

• Sarai Palanca Suela

  Autor

Grupos

• Infecciones Respiratorias

• Investigación Clínica y Traslacional en Cáncer

• Unidad de Biomarcadores y Medicina de Precisión (UBYMP)

Abstract

Next-generation sequencing (NGS) is a molecular approach able to provide a comprehensive molecular profile of non-small cell lung cancer (NSCLC). The broad spectrum of biomarker-guided therapies has positioned molecular diagnostic laboratories as a central component of patient clinical management. Here, we show the results of an UNE-EN ISO 15189:2022 NGS-accredited assay in a cohort of 350 patients. TP53 (51.0%), KRAS (26.6%) and EGFR (12.9%) were the most frequently mutated genes. Furthermore, we detected co-occurring and mutually exclusive alterations, as well as distinct molecular profiles according to sex and smoking habits. Actionable genetic alterations were significantly more frequent in female patients (80.5%, p < 0.001) and in never-smoker patients (87.7%, p < 0.001). When NGS was established as the main molecular testing strategy, 36.4% of patients received at least one line of targeted treatment. Among 200 patients with stage IV NSCLC, first-line treatment with targeted therapies was associated with a longer progression-free survival (PFS) (13.4 months (95% CI, 10.2-16.6) (p = 0.001)). Similarly, the overall survival (OS) of patients receiving at least one targeted drug was significantly longer (26.2 months (95% CI, 11.8-40.5) (p < 0.001)). Our results show that the implementation of NGS in the public healthcare system has provided a broader application of precision medicine.

Keywords

• molecular diagnosis; next-generation sequencing; non-small cell lung cancer; quality management system; translational research