e20760 Background: A primary concern in the integration of Next-Generation Sequencing (NGS) into first-line (1L) metastatic non-small cell lung cancer (mNSCLC) care is the potential for "diagnostic lag"—where the time required for molecular profiling delays treatment initiation. We sought to evaluate the operational efficiency of a large-scale community oncology molecular workflow by comparing the Time to Treatment (TTT) between patients receiving biomarker-driven targeted therapy and those receiving standard chemotherapy with or without checkpoint inhibitors. Methods: This retrospective study analyzed adults with stage IV mNSCLC (2024–2025) within a large community oncology network. Patients were segmented into two cohorts: the Targeted Cohort (Biomarker-positive B+; receiving guideline-concordant 1L targeted agents) and the Standard Cohort (Biomarker-negative B-; receiving 1L platinum-based chemotherapy and/or immune checkpoint inhibitors). TTT was defined as the interval from metastatic diagnosis to the first day of systemic therapy using a 14-day grace period for lab turn-around time. Comparative analysis focused on the kinetics of treatment initiation to determine if molecular testing requirements delayed therapy for the Targeted Cohort. Results: Among 1,552 patients (Targeted: n = 157; Standard: n = 1,395), the Targeted Cohort was younger (median 69 vs. 71 years) and had a higher proportion of females (67% vs. 50%). The median TTT for the Targeted Cohort was statistically shorter to the Standard Cohort 0.8 vs. 0.9 months (p = 0.003), demonstrating that the requirement for NGS results did not extend the window to treatment. While clinical endpoints were captured, differences in median OS (Not Reached for Targeted vs. 11.5 months for Standard) and Median TTNT (11.9 vs. 6.1 months; p < 0.0001) were attributed to the inherent differences in underlying disease biology and the high efficacy of targeted agents, rather than the velocity of treatment initiation. Conclusions: These data demonstrate that modern, integrated molecular workflows in the community setting successfully mitigate diagnostic lag for B+ mNSCLC. The initiation of targeted therapy occurs with equal or greater efficiency compared to standard cytotoxic or immunotherapy regimens. These findings suggest that the perceived risk of treatment delay for NGS testing is not supported by real-world evidence, reinforcing that diagnostic precision can be achieved without compromising the speed of care delivery in the 1L setting.
Su et al. (Thu,) studied this question.