Opinion: Comprehensive Genomic Profiling Is Vital for Optimizing NSCLC Care

Amanda Brink, DNP, APRN, FNP-BC, AOCNP

For patients with advanced non–small cell lung cancer (NSCLC), treatment decisions have become increasingly dependent on the results of molecular testing. Comprehensive genomic profiling (CGP), which detects hundreds of potential genetic alterations in a single tissue sample, is a powerful tool for identifying patients who may benefit from targeted therapies such as RET inhibitors, ALK inhibitors, and KRAS-directed treatments. These therapies often lead to better outcomes than traditional chemotherapy and expanding access to them ensures that more patients can benefit from these advances in care.

Oncology nurses play an essential role in ensuring that genomic testing is ordered promptly so that results are available as early as possible. They also help educate patients about the purpose of the test, support patients in understanding their results, and advocate for timely implementation of targeted therapies based on those results.

Genomic Profiling and NSCLC Targeted Treatment Adherence: Real-World Data

A recent real-world study analyzed data from over 1,400 patients with advanced NSCLC who underwent CGP through the Tempus xT assay. The goal was to assess whether patients with actionable genetic variants received the targeted therapies recommended by the National Comprehensive Cancer Network (NCCN) guidelines. Overall, the study found encouraging results: 86.3% of patients with a targetable mutation received appropriate therapy, and most began treatment within a median of 23 days from when their tumor was sequenced.

Notably, the study found that even when patients underwent CGP before a matched targeted therapy was officially recommended in the NCCN guidelines, many still received the appropriate therapy soon after the guideline updates, typically within about 3 months. For instance, patients with KRAS G12C mutations who were sequenced prior to June 2021 (when KRAS G12C-targeted therapy was added to the NCCN guidelines) still began treatment with sotorasib shortly after the guideline change, with a median time of 95 days. This highlights an important benefit of CGP: because it screens for a wide range of potential mutations, it can identify actionable biomarkers before therapies are formally recommended. As treatment guidelines evolve, CGP results remain relevant, allowing providers to act quickly when new therapies become available.

The study also found variation in adherence depending on the specific biomarker. For example, patients with EGFR mutations had the highest adherence, with 100% of those with exon 19 deletions receiving appropriate targeted therapy. On the other hand, patients with BRAF V600E mutations had the lowest adherence at 47%, despite guidelines recommending targeted therapy for this mutation since 2017. This discrepancy may be due to the complexity of BRAF-targeted treatment regimens and their adverse effect profiles, which require more nuanced management.

What Prevents the Use of CGP in NSCLC?

While CGP is becoming a standard part of care for patients with advanced NSCLC, several challenges still limit its widespread use. One major obstacle is inconsistent insurance coverage, especially from commercial insurers, which can make it difficult for some patients to access broad-panel testing. Additionally, some healthcare providers may be reluctant to order CGP because of concerns about its cost or uncertainty about how useful the results will be in guiding treatment.

Despite these concerns, the study showed that very few patients who did not have actionable genetic mutations were given targeted therapies outside of approved indications. This finding suggests that CGP does not lead to unnecessary or inappropriate treatments, addressing a common worry about overtreatment when broad genetic testing is used.

Patients with NSCLC largely received targeted treatment promptly following genomic profiling.

Nursing Considerations

For oncology nurses, these findings highlight the critical importance of understanding the basics of genomic testing in order to advocate confidently for CGP early in the patient’s treatment journey. Early testing can ensure that patients receive the most appropriate targeted therapies without delay, which can significantly improve outcomes. Nurses also play a vital role in educating patients and their families about the purpose of CGP and how test results guide personalized treatment plans, helping to increase patient engagement.

References

Ben-Shachar R, Nadhamuni K, Raez LE, et al. Real-World Adherence Patterns of Comprehensive Genomic Profiling to Biomarker Recommended Therapies in Patients With Advanced Non-Small Cell Lung Cancer. JCO Oncol Pract. Published online June 30, 2025. doi:10.1200/OP-24-00880