Timing of Next-Generation Sequencing (NGS) Relative to First-Line Therapy in Lung Cancer: Insights From the Global WAYFIND-R Registry

OBJECTIVES: Molecular profiling of tumors to guide personalized therapy can improve patient outcomes compared with standard-of-care therapies. Further real-world evidence on NGS utilization and its clinical impact on treatment selection is required.

METHODS: We analyzed anonymized data (Observation Medical Outcomes Partnership common data model) from patients with lung cancer in the global WAYFIND-R cancer registry (NCT04529122) describing real-world treatment patterns after NGS. Data were analyzed within the trusted research environment of the WAYFIND-R Data Sharing and Collaboration Platform.

RESULTS: Of 2738 patients enrolled from Aug 2020–Feb 2024, 638 had lung cancer. Median age at diagnosis was 65 years (range: 25–88 years); 54% of patients were men, 45% White, 44% from Europe, 46% former smokers, 18% current smokers, 67% had government insurance and 71% had an Eastern Cooperative Oncology Group performance status of 0–1.

Most NGS testing was performed in tissue samples (>90%); molecular tumor boards discussed 21% of cases. Of the 105 metastatic/relapsed patients with treatment data available, 55% received first-line therapy after NGS results (TXafterNGS) and 45% received first-line therapy before NGS results (TXbeforeNGS). Median time from diagnosis to NGS results was 30 days for patients with TXafterNGS and 253 days for patients with TXbeforeNGS. For TXafterNGS and TXbeforeNGS, respectively, first-line therapy was chemotherapy alone in 31% and 66% of patients; chemotherapy plus cancer immunotherapy in 29% and 21%; cancer immunotherapy alone in 28% and 9%; targeted therapy in 12% and 4%. Demographic, geographical and socioeconomic characteristics between TXafterNGS and TXbeforeNGS were similar.

CONCLUSIONS: In this cohort of patients with lung cancer, defining first-line treatment with NGS led to more targeted therapy and cancer immunotherapy than performing NGS after first‑line therapy. WAYFIND-R registry data will allow further studies on real-world NGS use and how it impacts treatment decisions and patient outcomes in routine cancer care through the research platform environment.