The following article features coverage from the American Society of Clinical Oncology 2020 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Approximately one-third of patients with advanced non-small cell lung cancer (NSCLC) with highly actionable gene variants were not prescribed available targeted agents, according to data from the US Department of Veterans Affairs (VA) National Precision Oncology Program (NPOP), a program established to provide access to next-generation sequencing (NGS) for veterans with advanced solid tumors.

“Efforts should be directed toward improving knowledge of providers and pathologists about optimal times to send for tumor DNA sequencing and the appropriate action of the results,” said Vishal Vashistha, MD, of Duke University Health System and Durham VA Health Care System, North Carolina, who presented the data as part of the ASCO20 Virtual Scientific Program. “Opportunities to ensure the appropriate documentation and review of NGS results may mitigate issues with lack of awareness of NGS results or lack of documentation of the same.”

Dr Vashistha and colleagues retrospectively looked at 1750 patients in the VA NPOP database with NSCLC who successfully underwent NGS. Data were reviewed for highly actionable gene variants with level 1 (ALK, BRAF, EGFR, ROS1) or level 2A (ERBB2, MET, RET) evidence. Patients with less than level 1 or 2A evidence for targeted treatments were excluded, and patients who had not received treatment options within at least 6 months following NGS were chosen for inclusion in the final analysis.

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Of these patients, 115 patients had National Precision Oncology Program level 1 and 2A gene variants, all within ALK, BRAF, EGFR, ERBB2, MET, and RET. Of the 115 patients, 32.2% of NSCLC patients (37 individuals) with level 1 or 2A evidence for targeted treatments did not receive targeted care.

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“A little more than one-quarter of patients who were found to have highly actionable gene variants with level 1 evidence were not prescribed targeted therapies, whereas, approximately one-half of patients showing level 2A evidence were not prescribed targeted therapies,” Dr Vashistha said.

Among the listed reasons for not prescribing a targeted agent, the most common was that the patient did not have stage 4 metastatic disease (32.4%). Other reasons were that the treating provider did not comment on NGS results in the patient’s clinical chart (24.3%), or that the provider did not feel that the patient was a candidate for targeted therapy due to toxicities and/or the patient’s performance status (19%). Only 2 out of 115 NSCLC patients with highly actionable gene variants never actually received targeted therapies that were prescribed and available to them.

Patients were not denied access to a level 1 or 2A targeted drug due to utilization-management review.

Read more of Cancer Therapy Advisor‘s coverage of the ASCO 2021 meeting by visiting the conference page.


Vashistha V, Armstrong J, Winski D, et al. Barriers to prescribing targeted therapies for NSCLC patients with highly actionable gene variants in the VA National Precision Oncology Program. Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 2005.