Association of Next Generation Sequencing and Routine Testing With Clinical Outcomes of Advanced Non-small Cell Lung Cancer Patients in a Real-world Setting

Abstract Purpose Next generation sequencing (NGS) has been used frequently in advanced non-small cell lung cancer (NSCLC) patients. Here, we investigated the treatment selections and clinical benefits of NGS technologies for patients with advanced lung cancer in a real-world setting.Methods This retrospective study enrolled patients with advanced NSCLC who received genetic testing. Patients received either NGS or routine testing (EGFR and/or ALK and/or ROS1 only). Clinical outcomes were compared between patients received NGS and those undergoing routine testing. Propensity score analysis was used to prevent survival bias associated with patient characteristics. Overall survival (OS) was the primary outcome. Results Of 6,451 patients with advanced NSCLC, 5,666 (87.8%) patients underwent routine testing (RT) and 785 (12.2%) were tested by NGS. The median OS was 22.6 months and the 5-year survival rate was 22.89%. Comparison of OS showed no difference according to propensity score analysis (24.8 months vs 24 months, P=0.533). With uncommon mutations, propensity score analysis showed that 1 and 2-year survival rate was significantly higher in the NGS testing group than in the routine testing group. This could be due to the higher rate of patients receiving targeted therapy (68.0% vs. 53.6%; P=0.042) and off-label drugs (28.10% vs. 11.40%; P=0.002).Conclusion NGS was not independently with a significant benefit comparing with RT in most advanced NSCLC patients. NGS could provide clinical value for rare mutations that were not available in RT, and the future benefits of NGS in immunotherapy need to be further explored.