Next Generation Sequencing (NGS) Testing for Cancer Patients at a Safety NET Hospital

ASCO 2023 Abstract
Authors Rizvan Azimzade, Maria Louise Avenido, Kevin B. Knopf, An Uche
Background:Next Generation Sequencing (NGS) testing is gradually becoming an essential aspect of cancer care. However, numerous studies have shown that non-White patients are under-represented in both precision oncology clinical trials and molecular testing. Highland General Hospital (HGH) is a community safety-net hospital in Oakland, California serving primarily Black, Hispanic and Asian patients. In an effort to increase health equity, in August 2020 we began to offer NGS testing with Tempus Labs, Inc. for our cancer patients. The purpose of this study is to document this experience and highlight the genomic profile of our patient population.


Methods:This is a retrospective chart review study. Patients were included if their tumor biopsy was sent for NGS testing from August 2020 to December 2022. A total of 165 patients had their samples sent for NGS, of which 148 were included in this study and 17 were excluded due to lack of sufficient tissue. Patient demographic data and predictive biomarkers were collected. For the purposes of this study, we defined predictive biomarkers as those that predict likelihood of response or lack of response to therapy as recommended by National Comprehensive Cancer Network guidelines.

Results:The racial distribution of our patient sample is shown in the table below. Consistent with the patient population of HGH, our sample included mostly Black (32.4%), Hispanic (26.4%), and Asian (21.6%) patients. Non-Small Cell Lung Cancer (NSCLC) and colorectal cancer (CRC) were the two most common malignancies sequenced at 34.5% and 25.7%, respectively. For NSCLC patients, 54.9% had predictive biomarkers, with EGFR and KRAS being the most common driver mutations. For CRC patients, 60.5% had predictive biomarkers, with 73.9% of those being NRAS/KRAS and 13.0% being high tumor mutational burden. Full results to be presented.

Conclusions:Based on our experience, it is feasible and informative to provide NGS testing for patients at safety-net hospitals. NGS testing allows for the most appropriate treatment selection for each patient, which can translate into better outcomes. Moreover, due to the unique demographics of patients from these hospitals, NGS tests can provide valuable information about the tumor genomic profiles of these underrepresented patients. This data can help improve drug development research and close the health equity gap.

Racial distribution of patient sample.
Race n % Total Sample % Cancer Type by Race
= 51
n = 38
n = 59
Asian 32 21.6 29.4 34.2 8.5
Black 48 32.4 39.2 26.3 32.2
Hispanic/Latino 39 26.4 15.7 23.7 37.3
Other 7 4.7 0 0 8.5
Pacific Islander 7 4.7 2 5.3 6.8
White 15 10.1 13.7 10.5 6.8

Note. N = 148. ?Other? Cancer = Non-NSCLC or Non-CRC. ?Other? Race = < 5.