Contemporary real-world patterns of precision medicine in metastatic NSCLC

The ASCO CancerLinq Discovery database was analyzed to identify patients diagnosed with stage IV NSCLC from the years 2019 to 2023. All analyses were descriptive in nature. Patient demographics, tumor characteristics, biomarker testing patterns, and treatment utilization were summarized using counts, percentages, means, medians, and standard deviations, as appropriate. Time intervals from biomarker testing to initiation of first-line therapy were calculated at the patient–biomarker level and summarized overall and by biomarker type. Data extraction was conducted using SQL-based cohort definitions, and summary statistics were generated using Microsoft Excel.

Among 10,658 patients with stage IV NSCLC identified in the updated analysis (2019–2023), 25% (n = 2,679) had documented biomarker testing, compared with 22% (n = 8,357) in the prior IASLC analysis. Demographic distributions were similar between cohorts (Table 1), with 70.7% White and 11.9% Black patients in the current cohort versus 66.6% and 13.1%, respectively, in the IASLC cohort; gender distribution was also comparable (51.8% female, 48.2% male vs 53.4% and 46.6%). The mean interval from biomarker testing to initiation of first-line therapy was 29.7 days (SD 93.6). Among patients with documented biomarker testing, 25.2% received targeted therapy, representing an increase compared with 8.1% in the IASLC analysis. Targeted therapies were directed against nine actionable oncogenic drivers whereas earlier analyses were largely limited to EGFR and ALK alterations.

This updated real-world analysis demonstrates the continued evolution of precision medicine in metastatic NSCLC, with expanded use of targeted therapies across nine actionable genomic alterations in a real-world population. Although biomarker testing rates appear modest, this likely reflects known limitations in capturing molecular diagnostics within real-world databases rather than true testing gaps. Ongoing analyses will evaluate survival outcomes and treatment patterns to better define the clinical impact of precision oncology in modern NSCLC care.