Research in context
Evidence before this study
We did a systematic review of the scientific literature to identify studies assessing nationwide routine molecular profiling of patients with advanced non-small-cell lung cancer (NSCLC) for one or more genetic alterations known (or supposed) to be oncogenic drivers. We searched PubMed for English language reports published up to Dec 3, 2010, with the terms “non small cell lung cancer”, “advanced” or “metastatic”, and “EGFR” or “ALK” or “BRAF” or “HER2” or “PIK3CA” or “KRAS” or “multiplex” or “sequencing” and “nationwide”, or names of various countries around the world. We also searched abstracts from ASCO and ESMO meetings (2007–10). We did not identify any published data.
Added value of this study
Our study shows that routine nationwide molecular profiling of patients with advanced NSCLC is feasible with an acceptable turnaround time in obtaining the results. Even with assessment of a limited number of genetic alterations (ie, currently six genes), the frequency of these genetic alterations might allow the consideration of targeted therapy for treating these patients (either commercially available for EGFR and ALK, or within a clinical trial for the other alterations). Finally, when a genetic alteration was detected, the outcome was a longer median overall survival, suggesting a possible prognostic advantage or a major change in the management of these patients with advanced NSCLC, or both.
Implications of all the available evidence
The Lung Cancer Mutation Consortium (LCMC) initiative (the largest multi-institutional study in developed countries) suggested that molecular profiling helps to orient patients towards targeted therapies and dedicated trials, and individuals with drivers receiving a matched targeted agent lived longer than patients who did not receive genotype-directed therapy. Our study extends the LCMC study to a nationwide scale, and suggests that routine nationwide molecular profiling provides a clinical benefit to patients with advanced NSCLC.