171P - Benefit of next-generation sequencing for lung cancer patients in a limited-resource area

Background

Lung cancer is one of the most common cancer in Thailand. As the advancement of precision oncology including targeted agent and immunotherapy, these dramatically improve patients' quality of life and survival outcome. Tumor mutational profiling are crucial for selecting the most appropriate treatment for patients, however with the lack of affordable testing platform and treatment modality are still the enormous gap, especially in the limited-resource area. This study aims to collect mutational data analysis of lung cancer patients who underwent next-generation sequencing (NGS) tumor testing, related treatment and cost.

Methods

The retrospective observational study was conducted in Lampang Hospital, Thailand. Patients diagnosed as non-small cell lung cancer (NSCLC) who underwent tumor mutational profiling by next-generation sequencing (NGS) were included in study. All patients were discussed thoroughly in term of utilization and affordability. Tumor samples were sent to accredited laboratory for mutational analysis.

Results

From May 2022 to May 2023, tumor tissue from eleven patients with lung cancer were sent for NGS testing. All patients were metastatic disease, which 91% were adenocarcinoma subtype. Eight samples (73%) were analyzed using QIAct lung DNA UMI panel on Illumina MiSeq or Qiagen GeneReader Instrument. Three were analyzed using Oncomine Focus Assay on Ion GeneStudio S5 instrument. Programmed Cell Death Ligand 1 (PD-L1) testing was performed using anti-PD-L1 antibody clone 22C3 immunohistochemical assay. Most frequent identified mutations were EGFR (45.4%), ALK (18.2%) and KRAS G12C (9.1%). Three (27.3%) had high PD-L1 expression (PD-L1 tumor proportion score ≥50%). These results lead to initiation of targeted therapy, as 60% of patients with EGFR mutation received first-generation tyrosine kinase inhibitor (TKI) and all of ALK-positive patients received second-generation TKI. Immunotherapy agents were also initiated in two patients (18.2%) with PD-L1 expression tumor. The mean costs for NGS assay were 877.48 USD per test.

Conclusions

Though the limited number of patients, tumor mutational profiling with next-generation sequencing technique provides crucial information and result in precision treatment delivery.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

K. Thanasombunsukh: Financial Interests, Personal and Institutional, Principal Investigator: Arcus Bioscience; Financial Interests, Personal, Invited Speaker: AstraZeneca Thailand, Novartis Thailand, Bayer Thai, Eisai Thailand. All other authors have declared no conflicts of interest.