World Conference on Lung Cancer 2024

Radiomics has potential for enhancing prognostication in metastatic non-small cell lung cancer (mNSCLC) patients treated with immunotherapy (IO). However, achieving generalizability across different centers remains a challenge for clinical adoption. The aim of this study was to develop and test a radiomics model to predict the risk of progression in IO-treated mNSCLC patients. The Risk Model, trained on PFS data and radiomics features extracted from CT scans of mNSCLC IO patients, successfully generalized to an external IO cohort. Results from the chemotherapy cohort suggest the model is predictive of risk of disease progression rather than response to IO therapy.

Researchers at Henry Ford Cancer Center and Tempus AI partnered to investigate racial differences in the prevalence of ALK gene alterations among 27,991 lung cancer patients tested with Tempus assays. Asian Pacific Islanders had the highest prevalence of ALK alterations, and Black or African American patients had the lowest. The majority of the detected alterations were ALK fusions and several novel fusion partners were identified exclusively in certain racial groups. The study highlights the importance of inclusive testing for understanding racial disparities in lung cancer genetics.

The team analyzed the Tempus multimodal real-world database to characterize invasive mucinous adenocarcinoma (IMA) of the lung. An analysis of 20,071 patients (n=699 IMA ; n=19,372 non-IMA) revealed significantly lower tumor mutational burden, less PD-L1 positivity, and distinct immune profiles in IMA patients, with increased M2 macrophages, Tregs, and NK cells. IMA patients also exhibited worse overall survival compared to non-IMA patients, emphasizing the need for further research into this rare lung cancer subtype.

The study examined the tumor immune microenvironment (TIME) differences between primary lung tumors and metastatic sites in patients with non-small cell lung cancer (NSCLC). The analysis from 6,534 NSCLC patients in the Tempus multimodal real-world database indicated that liver, CNS and bone mets had immune cell proportions that were consistent with a less immunogenic TIME when compared to primary lung tumors. The study suggests that the immune landscape of metastatic sites may be a consideration for patient management and should be an area of further research.

This study analyzed data from Tempus’ multimodal real-world database to identify the prevalence of care gaps for early-stage NSCLC patients, and determine how often patients are not receiving NCCN-recommended EGFR testing. The team found that of the 39/913 patients qualifying for EGFR testing according to 2022 NCCN Guidelines, 33% (13/39) did not receive molecular testing for EGFR mutations. Furthermore, 77% (10/13) of those patients who were not tested had an actionable biomarker testing care gap, meaning they may have benefitted from molecular testing. These results highlight an opportunity to close the care gap through interventions such as care pathway automation tools.

The research team leveraged the Tempus multimodal real-world data library to assess whether concurrent RNA and DNA sequencing of advanced-stage NSCLC patients can enhance the detection of rare fusions (BRAF, NRG1, and EGFR), as well as to report on their prevalence in this population. Concurrent DNA and RNA sequencing improved the ability to detect emerging rare fusion variants compared to DNA sequencing alone, doubling the number of these rare fusion variants that were detected. Additionally, the team found that half of all patients with a detected BRAF fusion also harbored an EGFR co-variant (e.g., exon 19 deletion, T790M), a finding with implications for better understanding resistance mechanisms in response to EGFR-directed therapies.