Comprehensive Genomic Profiling in Advanced Non-Small Cell Lung Cancer: A Real-World Cohort Study in Finland

BACKGROUND: Non-small cell lung cancer (NSCLC) is a disease with a low survival rate and poor prognosis. Targeted therapies have improved treatment outcomes as driver mutations have been identified, especially in adenocarcinomas. Comprehensive genomic profiling (CGP) provides insights into the genetic mutation profile of cancer and helps identify actionable mutations. The mutational landscape of cancer varies based on the patient's ethnic background, and there is limited information on the genetic profile of NSCLC within the Finnish population.

MATERIAL AND METHODS: We analysed the genetic mutational profile of 96 advanced NSCLCs that underwent CGP between November 2021 and March 2023 at Tampere University Hospital. Additionally, we compared the genomic alterations in our cohort with those in the international datasets.

RESULTS: Clinically actionable alterations associated with a targeted therapy were identified in 45% of patients, including 63% of never-smokers and 41% of ever-smokers. The most common actionable alteration was KRAS G12C (18%), followed by EGFR alterations (14%). However, only 33% of the patients with an actionable alteration received targeted therapy. The median tumour mutational burden (TMB) was 5, with 31% of patients exhibiting a TMB greater than 10.

CONCLUSIONS: CGP affects the treatment strategies for NSCLC. Nearly half of our entire cohort had a genetic alteration eligible for approved targeted therapies. Besides these findings, CGP provides additional data to assess treatment decisions and outcomes, including co-occurring genetic alterations and TMB. In real-world clinical practice, the practical application of this information can be restricted by the varying unavailability of optimal treatments.