Real-world utilization of upfront genomic testing in newly diagnosed non–small cell lung cancer in a rural state.

e23377 Background: Comprehensive genomic testing (NGS) to inform biomarker-driven therapy is a standard recommendation in patients with metastatic non-small cell lung cancer (NSCLC). There is emerging evidence to support testing in early-stage NSCLC. Maine has a high incidence of lung cancer and is the most rural state with the oldest population in the U.S. Real-world genomic test utilization in this setting has not been well-characterized. Methods: We conducted a retrospective study of adults with biopsy-confirmed stage IB-IV NSCLC diagnosed between April 2020 and September 2024 in the MaineHealth Cancer Care Network. NGS results closest to diagnosis were obtained from Tempus (Chicago, IL) and demographic and clinical data from our tumor registry and EMR. Zip codes were used to determine rurality. Utilization was compared across subgroups using Wilcoxon rank-sum and Chi-square tests. Results: Among 1,024 patients with stage IB-IV NSCLC, 435 (42.5%) underwent upfront genomic testing with a median age of 69 years; 53.1% female, 98.6% white, and 55.6% Medicare enrollees. Compared with those who did not receive testing, tested patients were younger (69 vs. 72 years), more often adenocarcinoma (70.6% vs. 45.7%), and more often former (69.2% vs. 63.3%) or never smokers (10.8% vs. 5.4%). In stage IV disease (N = 621), testing was more common at the academic cancer center compared to community sites (60.8% vs. 52.8%, p = 0.045). In early-stage disease (IB-III, N = 403) and adenocarcinoma (N = 576), testing was more frequent among urban residents (80.6% vs 71.7%, p = 0.044; 70.6% vs. 61.9%, p = 0.029, respectively). In squamous cell carcinoma (SCC, N = 252), testing was more common at community sites (44.9% vs. 31.9%, p = 0.04). Testing rates trended up from 2020 to 2024 in stage IV disease and adenocarcinoma, but remained variable in early-stage disease and SCC as depicted in the table. Conclusions: Fewer than half of patients with stage IB-IV NSCLC underwent upfront comprehensive genomic profiling across a statewide network. Testing was less common among rural residents and those treated at community sites in early stage, stage IV, and adenocarcinoma. Patients with SCC were more likely to be tested in the community, possibly reflecting practice variation or small sample size. While testing rates increased in stage IV disease and adenocarcinoma over time, patterns in early-stage and SCC fluctuated, likely influenced by evolving guideline recommendations. Our findings highlight gaps in access to precision oncology in Maine and underscore the need for improvements, such as the implementation of reflex testing algorithms, enhanced physician and patient awareness, and financial support. Year Stage IV Adenocarcinoma Early-Stage SCC 2020 (Apr-Dec) 33.9% 37.9%, 33.3%, 32.4% 2021 42.1% 41.6% 19.2% 25.5% 2022 46.5% 60.6% 43.3% 33.9% 2023 49.6% 66.4% 54.8% 47.1% 2024 (Jan-Sep) 51.4% 55.9% 38.7% 37.3%