Abstract 1699P
Background
Systematic molecular profiling has emerged this last decade as a cornerstone of management of advanced nonsquamous (NSq) Non-Small Cell Lung Cancer (NSCLC). However, access to these analyses may be heterogeneous especially between academic and non-academic centers. We sought to study the proportion of patients who benefit from a complete molecular profile in the real-world setting.
Methods
Between 01/01 and 12/31/2020, all patients diagnosed with a lung cancer in one of the 82 participating centers from the French Pulmonologist College of General Hospital (CPHG), were included in a national prospective cohort study (KBP-CPHG 2020). The results of molecular testing were systematically collected at diagnosis. A sister study was conducted in 2010. For this analysis, we considered all patients with an advanced stage non-squamous NSCLC.
Results
KBP-2020-CPHG cohort included 8,999 patients with a diagnosis of lung cancer. From the general population, 3,560 patients had an advanced stage NSq NSCLC. Overall, 3,122 patients (87.7%) had at least one molecular analysis in 2020, as compared to 1,434 (53.0%) in 2010. Regarding alterations for which an approved drug is available in France, testing of EGFR mutation, ALK and ROS1 rearrangement and BRAF mutation was performed in 2,634 (74.3%), 2,772 (78%), 2,390 (67.3%) and 1,913 (53.9%) patients respectively. Results of other alterations are reported in Table. Of note, 11.5% of patients were analyzed for RET and 9% for NTRK. Table: 1699P
Alteration testing
| Tested | Positive | |||
| Gene | N (3,560) | % | N | % |
| EGFR | 2,634 | 74.3% | 392 | 14.9% |
| ALK | 2,772 | 78% | 74 | 2.7% |
| ROS1 | 2,390 | 67.3% | 39 | 1.6% |
| BRAF | 1,913 | 53.9% | 93 (V600E, 43) | 4.9% 2.2% |
| KRAS | 2,040 | 57.6% | 773 (G12C, 404) | 37.9% (19.8%) |
| HER2 | 1,562 | 44.1% | 28 | 1.8% |
| cMET ex14 | 1,183 | 33.4% | 55 | 4.6% |
| RET/NTRAK1/NRG1 | 407/312/239 | 11.5%/8.8%/4.6% | 10/1/0 | 2.5%/0.3%/0% |
Conclusions
Molecular testing has been remarkably implemented in the diagnostic work-up of advanced NSq NSCLC patients in routine practice in non-academic hospitals in France. Alterations detectable by immunohistochemistry or NGS are those which are most easily tested. Efforts should be made on detection of rare fusion transcripts.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
CPHG (College des Pneumologues des Hôpitaux Généraux).
Funding
The present study was promoted by the French College of General Hospital Pulmonologists (CPHG) with the endowment funds of Fondation du Souffle, Le Nouveau Souffle, Couleur espoir, the labeling of InCa (Institut national du Cancer) and FHF-CNCR (Fédération Hospitalière de France-Comité National de Coordination de la Recherche), and financial support of following laboratories: AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Chugai, Janssen, MSD, Lilly, Pfizer, Roche, Sanofi and Takeda.
Disclosure
A. Cortot: Financial Interests, Personal, Advisory Role: AstraZeneca, Novartis, Roche; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Invited Speaker: AstraZeneca, BMS, MSD, Pfizer, Novartis, Takeda, Janssen, Roche. S. Couraud: Financial Interests, Personal, Advisory Role: Amgen, AstraZeneca, BMS, Boehringer, MSD, Roche, Sanofi, Takeda, BMS. D. Debieuvre: Financial Interests, Personal, Advisory Role: AstraZeneca, Roche, Pfizer, BMS, MSD, Novartis, GSK, Janssen, Amgen, OSE Immunotherapeutics, Sanofi Aventis. All other authors have declared no conflicts of interest.