Geoffrey Oxnard, MD, Clinical Development Medical Affairs, Foundation Medicine, Boston, MA, discusses results from a real-world study comparing treatment prior to receipt of comprehensive genomic profiling vs treatment after receipt of comprehensive genomic profiling in patients with advanced non-small cell lung cancer (NSCLC), in order to see how this factor influenced various treatment regimens.

This study was presented at the virtual ESMO Congress 2021.

Transcript:

Hi. My name is Dr. Geoff Oxnard. I am an oncologist. I am a VP and Head of Clinical Development at Foundation Medicine. I also see patients at Boston Medical Center. I'm describing a poster we presented at ESMO, looking at comprehensive genomic profiling and practice patterns in patients with advanced non-small cell lung cancer.

In all of oncology, really, there is a growing tension between two flavors of therapy we can give -this is the way I see it as an oncologist- which is precision therapies, those pills or immunotherapies that can lead to fantastic responses with few side effects, and empiric therapies, the guesswork of trying chemo, trying a combination.

We know that we can help patients get those precision therapies through testing, but we want to study that actually in the real world. How do clinicians use diagnostics to steer them away from those empiric therapies and towards precision therapies? We initiated a real-world outcomes analysis to look at this question.

Here's the experiment: we look at first-line non-small cell lung cancer in a clinical genomic database, which is an alignment between the Foundation Medicine NGS results and the Flatiron Health real-world data.

In this database, we take patients with advanced non-small cell lung cancer starting first-line therapy, and we look at the window between PD-L1 testing results, which can ungate receipt of immunotherapy, and CGP results, which can ungate additional genomic information to get you additional targeted therapies.

The question we asked is, "In those patients who are getting PD-L1 testing and NGS, how is the treatment different for those who start treatment before getting their NGS results versus those who start treatment after getting their NGS results?"

In this experiment, we're asking, "Does the receipt of the NGS results change the flavor of the kind of therapy these patients with advanced non-small cell lung cancer can get in the first line?"

In this experiment, we ended up studying about 500-plus patients with advanced lung cancer. The good news is the majority of them received their treatment after NGS results are received. They are able to wait until the NGS results.

There are some patients though, 15%, who initiate treatment before the CGP results are back, for whatever reasons, because the clinician isn't willing to wait for the results, the patient isn't willing to wait for the results.

We then look at the practice patterns between those two groups. As you can imagine, in the 15% who initiate treatment before CGP results come back, guess what. Their therapy flavors towards more empiric treatment, more chemo, more chemo immunotherapy. The majority of them are receiving chemotherapy-based regimens. The minority are receiving immunotherapy alone or targeted therapy.

Take those patients then who receive treatment after the CGP results come back. It's reversed. The majority of those are now receiving immunotherapy or targeted therapy. The minority are now receiving chemotherapy-based regimens.

What's fascinating in particular is that the number of patients receiving immunotherapy goes up. That's both in the overall PD-L1-positive group and also in the PD-L1 greater than 50% group. The number of patients getting immunotherapy alone, without chemotherapy, goes up in those who start treatment after CGP results.

That's that idea that genomics actually gives us more confidence in giving immunotherapy, in ruling out driver mutations, like EGFR, ALK, ROS, RET, giving us signals like TMB that enable you to give immunotherapy.

Indeed, in a final experiment we looked at, we looked at a bunch of patients who got chemoimmunotherapy and then got CGP results, to say, "In those patients who are getting first-line empiric combination therapy, are there patients who are missing out on a chance at precision therapy?"

Actually, what do you know? 11% of those patients had a driver that could have gotten them a single-agent targeted therapy approach, a pill therapy, if only they had gotten that CGP up front.

The overall observation is that we're seeing delivery of CGP results we think can help docs make the right decision for a patient and steer away from the more toxic, the more potentially expensive combination therapies, and towards the more patient-centered precision therapies that we really see as the future of where lung cancer care is going.

If there's a final question I have, it's "What can we do to better create access to this testing so that patients have that chance of steering away from these chemo-based regimens and towards more precision regimens?"

That means we need to get our tests out there and available. It means we need to learn how to use CGP based on tissue or based on liquid. Actually, mixing together liquid biopsy, tissue testing, I think together we can get these results into doctors' hands so that they make these better decisions and get more and more patients on precision options.