In advanced non-small cell lung cancer (NSCLC), patients with actionable genomic alterations may derive additional clinical benefit from targeted treatment compared to cytotoxic chemotherapy. Current guidelines recommend extensive testing with next generation sequencing (NGS) panels. We investigated the impact of using a targeted NGS panel (TruSight Tumor 15, Illumina) as reflex testing for NSCLC samples at a single institution. Molecular analysis examined 15 genes for hotspot mutation variants, including AKT1, BRAF, EGFR, ERBB2, FOXL2, GNA11, GNAQ, KIT, KRAS, MET, NRAS, PDGFRA, PIK3CA, RET and TP53 genes. Between February 2017 and October 2020, 1460 samples from 1395 patients were analyzed. 1201 patients (86.1%) had at least one variant identified, most frequently TP53 (47.5%), KRAS (32.2%) or EGFR (24.2%). Among these, 994 patients (71.3%) had clinically relevant variants eligible for treatment with approved therapies or clinical trial enrollment. The incremental cost of NGS beyond single gene testing (EGFR, ALK) was CAD $233 per case. Reflex upfront NGS identified at least one actionable variant in more than 70% of patients with NSCLC, with minimal increase in testing cost. Implementation of NGS panels remains essential as treatment paradigms continue to evolve.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, affecting motor, sensory, and autonomic function. Accurate assessment is important during treatment, when CIPN may necessitate dose reductions or discontinuation, and after treatment, as chronic CIPN can greatly impact quality of life and safety in cancer survivorship. Measurement tools can include subjective measures, including clinician-based grading scales or patient-reported outcome measures (PROMs), and objective measures. This review aimed to summarize current CIPN assessment tools, highlighting characteristics such as feasibility, minimum clinically important differences (MCIDs), validity and reliability to allow for comparison and selection of tools by clinicians and researchers. Methods: Following the Scale for the Assessment of Narrative Review Articles methodology guidelines, 2 investigators performed a comprehensive literature search using predefined search terms relating to CIPN measurement. Additional papers were identified through a search of prior systematic reviews and tracing back references from key articles. Data were extracted from source papers and any available appendices. Results: We identified 3 clinician-based grading scales, 20 PROMs, and 8 objective measurement tools. While the majority of tools have been validated for neuropathy, a minority of them have established MCIDs and validation in CIPN-specific populations. Conclusions: Tool selection should align with the specific needs of clinicians and researchers. Instruments that are valid, reliable, and assess multiple CIPN domains are recommended. Further research is needed to validate many of these tools in CIPN-specific populations and to determine their MCIDs.

Liquid biopsy is recommended to diagnose molecular resistance to targeted therapy in patients with lung cancer. Nevertheless, not all jurisdictions provide funding and patient access. We report patients’ perceived value of liquid biopsy in targeted therapy resistance. Canadian patients participating in a national EGFR T790M liquid biopsy validation study completed structured interviews measuring perceived value and willingness-to-pay for plasma circulating tumor DNA testing as an alternative to tumor biopsy using open-ended and iterative bidding approaches. A total of 60 patients with advanced lung cancer participated with a median age of 64 years (range: 31–87 y); 69% were Asian and 45% female. All had received prior EGFR tyrosine kinase inhibitor; 17% also received chemotherapy. All patients preferred to have plasma testing over repeat tumor biopsy. In the context of the Canadian publicly funded system, patients estimated that a median of 300 (interquartile range: 150–800) Canadian dollars was a reasonable price to pay for liquid biopsy. Patients were personally willing to pay a median 100 (interquartile range: 33–350) Canadian dollars. In a system that covers the cost of standard diagnostic tests, patients with lung cancer indicated high willingness-to-pay out-of-pocket for liquid biopsy in the setting of acquired targeted therapy resistance. Patients have high perceived value of plasma genotyping and prefer it to repeat tumor biopsy.