Key Points:
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Only 30% to 40% of patients with the most common cancers undergo next-generation sequencing (NGS) testing.
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Of those who are tested, a significant portion receive results within three months of their death.
Overview from ASCO 2025 Annual Meeting:
A recent study presented at the ASCO Annual Meeting revealed that most patients with advanced or metastatic cancers in the U.S. do not receive next-generation sequencing (NGS) testing. Among those who do, many receive the results late in their disease progression—sometimes just months before death.
Study Insights:
Dr. Chadi Hage Chehade, a postdoctoral fellow at Huntsman Cancer Institute, explained that NGS is a powerful tool that helps identify genetic mutations which could inform targeted treatments and improve survival. Previous research had already noted low NGS use among patients with metastatic prostate and urothelial cancers. This study expanded the analysis to include the five most common advanced cancers: non-small cell lung cancer (NSCLC), breast, prostate, colorectal, and pancreatic cancers.
Methodology:
The study used real-world data from the Flatiron Health database, covering 280 cancer clinics since 2011. It included patients with one of the five cancers who had documented NGS results and a known date of death. Patients were categorized based on when they received NGS results: more than 3 months before death, within 3 months, or after death.
Findings:
Out of over 190,000 patients:
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Only about one-third of patients in each cancer group had undergone NGS testing.
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NSCLC: 36.3%
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Breast: 32.1%
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Colorectal: 41%
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Prostate: 30.9%
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Pancreatic: 35.4%
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Among those tested and with recorded deaths:
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Most received results more than 3 months before death (e.g., 85.4% for prostate cancer, 72.3% for NSCLC).
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However, around 25% of NSCLC and pancreatic cancer patients received results within 3 months of death.
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A small portion (1.1% to 2.4%) received results posthumously.
Implications:
Dr. Chehade emphasized the concern that many patients may be tested too late to benefit from potentially life-extending targeted therapies. While it’s encouraging that earlier testing has increased over the last decade, further improvements are needed.
Limitations & Next Steps:
Researchers acknowledged limitations like missing data and inherent bias from using electronic health records. Future research aims to identify why delays in NGS testing occur and how to ensure earlier testing so patients can access appropriate therapies while they’re still likely to benefit.
Conclusion:
To fully utilize the benefits of personalized medicine, NGS testing must occur earlier in the treatment journey. Delayed testing limits the chances for patients to receive potentially life-saving therapies in time.
