Broad-based genomic sequencing in advanced non-small cell lung cancer in the dock

摘要

The recently published study of Presley and colleagues ( ) aimed to ascertain if there is an association between broad-based genomic sequencing (defined as multigene Next-Generation Sequencing panels of 30 or more genes) and better survival in patients with advanced non-small cell lung cancer (NSCLC). For this purpose, the authors retrospectively analyzed data obtained from medical records of a large cohort of patients (n=5,688) with NSCLC from January 2011 to July 2016, treated in 191 community oncology practices across the United States. Overall, broad-based genomic sequencing was performed for 875 patients (15.4%) and routine genomic testing (testing of only) for 4,813 patients (84.6%). These two groups were compared for two parameters: the 12-month mortality using an instrumental variable approach and the overall survival with a propensity score-matched survival analysis. According to these analyses, the authors found no significant association between broad-based genomic sequencing and 12-month mortality [predicted probability of death: 41.1% for broad-based genomic sequencing 44.4% for routine testing; difference −3.6%, (95% CI, −18.4% to 11.1%)] or overall deaths [42.0% 45.1%; hazard ratio, 0.92 (95% CI, 0.73–1.11)], despite the unadjusted Kaplan-Meier survival analysis showing better survival with broad genomic sequencing [hazard ratio 0.69 (95% CI, 0.62–0.77); log-rank P<0.001]. The authors concluded that the use of broad-based genomic sequencing for advanced NSCLC in the community setting is not independently associated with a survival advantage. The study conducted by Presley ( ) presented interesting data about the use of broad genomic approach as compared to routine genomic testing across different community oncology practices and among a large cohort of patients with NSCLC. However, some considerations are needed regarding the usefulness of multi-gene approach and the potential clinical benefit of targeted treatment.