Impact of Molecular Testing Using Next-Generation Sequencing in the Clinical Management of Patients with Non-Small Cell Lung Cancer in a Public Healthcare Hospital

SIMPLE SUMMARY: Precision medicine has revolutionized the treatment of advanced non-small cell lung cancer (NSCLC). Due to the discovery of novel predictive biomarkers, an exhaustive molecular characterization of the disease is required for adequate clinical management. In this research, we aim to evaluate the implementation of next-generation sequencing (NGS) in routine diagnostics under a quality management system. In a cohort of 350 patients, NGS studies were able to reveal a distinct molecular profile of the disease according to sex and smoking status, as well as co-occurring and mutually exclusive relationships between molecular alterations. In stage IV patients, targeted therapies were associated with longer progression-free and overall survival. NGS has expanded precision medicine in our center by increasing the percentage of patients with actionable molecular alterations. Our findings consolidate the use of NGS as a molecular diagnostic tool in the clinical routine of a public healthcare hospital. ABSTRACT: Next-generation sequencing (NGS) is a molecular approach able to provide a comprehensive molecular profile of non-small cell lung cancer (NSCLC). The broad spectrum of biomarker-guided therapies has positioned molecular diagnostic laboratories as a central component of patient clinical management. Here, we show the results of an UNE-EN ISO 15189:2022 NGS-accredited assay in a cohort of 350 patients. TP53 (51.0%), KRAS (26.6%) and EGFR (12.9%) were the most frequently mutated genes. Furthermore, we detected co-occurring and mutually exclusive alterations, as well as distinct molecular profiles according to sex and smoking habits. Actionable genetic alterations were significantly more frequent in female patients (80.5%, p < 0.001) and in never-smoker patients (87.7%, p < 0.001). When NGS was established as the main molecular testing strategy, 36.4% of patients received at least one line of targeted treatment. Among 200 patients with stage IV NSCLC, first-line treatment with targeted therapies was associated with a longer progression-free survival (PFS) (13.4 months (95% CI, 10.2–16.6) (p = 0.001)). Similarly, the overall survival (OS) of patients receiving at least one targeted drug was significantly longer (26.2 months (95% CI, 11.8–40.5) (p < 0.001)). Our results show that the implementation of NGS in the public healthcare system has provided a broader application of precision medicine.