Association of Patient Characteristics and Tumor Genomics With Clinical Outcomes Among Patients With Non–Small Cell Lung Cancer Using a Clinicogenomic Database

作者：Gaurav Singal, Peter G. Miller, Vineeta Agarwala, Gerald Li, Gaurav Kaushik, Daniel Backenroth, Anala Gossai, Garrett M. Frampton, Aracelis Z. Torres, Erik Lehnert, David Bourque, Claire O’Connell, Bryan Bowser, Thomas Caron, Ezra Baydur, Kathi Seidl-Rathkopf, Ivan Ivanov, Garrett Alpha-Cobb, Ameet Guria, Jie He, Shannon Frank, Allen C. Nunnally, Mark Bailey, Ann Jaskiw, Dana Feuchtbaum, Nathan C. Nussbaum, Amy P. Abernethy, Vincent A. Miller · 发表于：JAMA · 年份：2019 · DOI：10.1001/jama.2019.3241 · 被引用次数：573 · 研究领域：Lung Cancer Treatments and Mutations、Lung Cancer Diagnosis and Treatment、Cancer Genomics and Diagnostics

Importance: Data sets linking comprehensive genomic profiling (CGP) to clinical outcomes may accelerate precision medicine. Objective: To assess whether a database that combines EHR-derived clinical data with CGP can identify and extend associations in non-small cell lung cancer (NSCLC). Design, Setting, and Participants: Clinical data from EHRs were linked with CGP results for 28 998 patients from 275 US oncology practices. Among 4064 patients with NSCLC, exploratory associations between tumor genomics and patient characteristics with clinical outcomes were conducted, with data obtained between January 1, 2011, and January 1, 2018. Exposures: Tumor CGP, including presence of a driver alteration (a pathogenic or likely pathogenic alteration in a gene shown to drive tumor growth); tumor mutation burden (TMB), defined as the number of mutations per megabase; and clinical characteristics gathered from EHRs. Main Outcomes and Measures: Overall survival (OS), time receiving therapy, maximal therapy response (as documented by the treating physician in the EHR), and clinical benefit rate (fraction of patients with stable disease, partial response, or complete response) to therapy. Results: Among 4064 patients with NSCLC (median age, 66.0 years; 51.9% female), 3183 (78.3%) had a history of smoking, 3153 (77.6%) had nonsquamous cancer, and 871 (21.4%) had an alteration in EGFR, ALK, or ROS1 (701 [17.2%] with EGFR, 128 [3.1%] with ALK, and 42 [1.0%] with ROS1 alterations). There were 1...