Abstract 1259P
Background
Tx options for METex14 NSCLC have been limited to chemotherapy (Ctx), immunotherapy (IO) and multikinase inhibitors (MKi) until the FDA approvals of selective MET inhibitors (METi) from 2020. Timing of NGS testing in relation to systemic first-line Tx (1L) initiation and Tx selection patterns for METex14 NSCLC pts in the real-world prior to those approvals warrants evaluation to guide future practice.
Methods
US electronic health record-derived de-identified Flatiron Health Foundation Medicine clinico-genomic database (FH-FMI CGDB) and COTA NSCLC database were evaluated. Pts were ≥18 years old, diagnosed with advanced/metastatic NSCLC from Jan 1, 2011, with NGS-confirmed METex14, ≥1 line of Tx, and ≥90 days follow-up from 1L initiation to cutoff date (FH-FMI CGDB: Jun 2020; COTA: Dec 2020). We examined NGS timing in relation to 1L initiation and Tx selection as 1L and subsequent therapy. Here we focus on FH-FMI CGDB data.
Results
Among 148 METex14 NSCLC pts identified, median age was 75 years; 85 (57%) were women, 94 (64%) had stage IV NSCLC at diagnosis, and 140 (95%) were treated in a community setting. An NGS report was available before 1L initiation in 56 pts (38%), of whom 38% received Ctx +/- IO (n=21), 27% IO monotherapy (n=15), 27% MKi (n=15). Pts with an NGS report on/after 1L (n=92; 62%) more often received 1L Ctx +/- IO (n=64; 69%), more rarely IO (n=15; 16%) and MKi (n=5; 5%). 42 (47%) did not receive subsequent Tx after the report. Over the last decade, the proportion of pts with the NGS report before starting 1L steadily increased from 8-17% in 2014-2015 to 65% in 2019.
Conclusions
This study describes NGS timing and Tx patterns in US pts with METex14 advanced NSCLC in the last decade, before the approvals of selective METi. Compared with pts with NGS reports prior to starting 1L, more pts with an NGS report on/after 1L initiation started with Ctx, although there is an increasing trend in recent years for NGS testing to occur before starting 1L. Almost half of pts with the report on/after 1L initiation had no documented subsequent Tx, highlighting the importance of testing pts upfront to guide Tx from 1L as new targeted therapies become available.
Clinical trial identification
Editorial acknowledgement
Medical editorial assistance was provided by Ana Costa, PhD of Chameleon Communications, London, UK, which was funded by Novartis, East Hanover, NJ, USA.
Legal entity responsible for the study
Novartis.
Funding
Novartis.
Disclosure
X. Le: Financial Interests, Personal, Other, Consulting/advisory: EMD Serono (Merck KGaA); Financial Interests, Personal, Other, Consulting/advisory: AstraZeneca; Financial Interests, Personal, Other, Consulting/advisory: Spectrum Pharmaceutics; Financial Interests, Personal, Other, Consulting/advisory: Eli Lilly; Financial Interests, Personal, Other, Consulting/advisory: Boehringer Ingelheim; Financial Interests, Personal, Other, Consulting/advisory: Bristol Myers Squibb; Financial Interests, Personal, Other, Consulting/advisory: Celgene; Financial Interests, Institutional, Research Grant: Eli Lilly; Financial Interests, Institutional, Research Grant: Boehringer Ingelheim. J. Martinalbo: Financial Interests, Personal, Full or part-time Employment: Novartis; Financial Interests, Personal, Stocks/Shares: Novartis. A. Holynskyj: Financial Interests, Personal, Full or part-time Employment: Novartis. V. Pretre: Financial Interests, Personal, Full or part-time Employment: Novartis; Financial Interests, Personal, Stocks/Shares: Novartis. F. Ye: Financial Interests, Personal, Full or part-time Employment: Novartis; Financial Interests, Personal, Stocks/Shares: Novartis. J. Morrissette: Financial Interests, Personal, Other, Consultant: Novartis; Financial Interests, Personal, Other, Consultant: Bayer; Financial Interests, Personal, Invited Speaker: NCCN; Financial Interests, Personal, Stocks/Shares: ThermoFisher; Non-Financial Interests, Personal, Other, Member, Board of Managers: Goal Consortium. All other authors have declared no conflicts of interest.