In recent years, tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) have become part of the adjuvant treatment paradigm for stage IV non-small cell lung cancer (NSCLC). Both modalities have demonstrated increased overall survival in select patient biomarker populations, including those tested for PD-L1 status and EGFR mutations. However, the NCCN also recommends testing for seven other gene alterations in metastatic disease to assist with choosing the optimal treatment. Whether expanded multigene testing could also benefit early stage NSCLC patients hasn't been established.
Using the Flatiron Health-Foundation Medicine Clinico-Genomic Database, researchers retrospectively reviewed the comprehensive genomic profiling (CGP) on tissue specimens from patients with early and advanced stage lung adenocarcinoma (LUAD) to assess the potential value of multi-gene testing.
Why this matters
While testing for PD-L1 and EGFR is pivotal for treatment selection, using CGP for multi-gene testing can guide treatment selection in a more timely manner, enabling a faster start of first-line protocols and helping patients avoid unnecessary side effects and ineffective treatments.
Additionally, this approach may be more cost-effective in avoiding the use of adjuvant ICI in patients with specific genetic drivers that have previously lacked activity with ICI in metastatic disease.