PURPOSE – The National Comprehensive Cancer Network (NCCN) guidelines recommend comprehensive genomic profiling (CGP) for identifying advanced non–small cell lung cancer (NSCLC) patients eligible for targeted treatment, with frequent updates to incorporate new variant-targeted therapies. CGP panels can identify multiple actionable biomarkers from a single sample to match patients to targeted therapies. We assessed the adherence rate of NCCN recommendations to variant-specific matched therapy, the impact of timing of guideline updates on adherence rates, and time from sequencing to new targeted therapy adoption.

METHODS – We conducted a retrospective cohort study of stage IV NSCLC patients, with Tempus xT tissue-based sequencing. Adherence to NCCN-recommended therapy was defined as the proportion of patients who initiated guideline directed targeted therapy when the presence of an actionable variant was identified.

RESULTS – Among the 1,407 evaluable patients, 233 patients had a NCCN-recommended targetable variant. The treatment adherence rate was 86.3% (N 5 201) with median time from sequencing to targeted therapy initiation of 23 days. A subset of adherent patients (13.4%, n 5 27) had targetable variants identified prior to guideline recommendation for testing, but received matched targeted therapy within a median of 96 days of new guidelines recommendations. The variant specific adherence rate was correlated with the timing of guideline recommendation (P 5 .02, Wald test), with lower adherence rates for variant-matched therapies recently included into guidelines.

CONCLUSION – In a large, real-world cohort of advanced NSCLC patients tested with CGP, the treatment adherence rate to matched NCCN-recommended targeted therapy was high. This study highlights the importance of CGP testing in identifying variants to provide timely matched targeted therapy in a rapidly evolving biomarker and therapeutic landscape.

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