Neeraj Agarwal: Hi. My name is Dr. Neeraj Agarwal. I'm a professor of Medicine and director of Genitourinary Oncology Program at the Huntsman Cancer Institute, University of Utah. Today, I'd like to welcome Dr. Chadi Chehade, who is also from Huntsman Cancer Institute, to talk about his data he is presenting in an oral presentation at the ASCO 2025 meeting.

So, Chadi, first of all, congratulations. At such an early stage of your career, you have a rapid oral presentation at the ASCO 2025 meeting, talking about data from almost 200,000 patients, and how genomic sequencing was utilized in those patients. And just for our viewers, these are the patients with most common cancers seen in the US, who have targeted therapies based on underlying genomic mutations approved-- so patients with prostate cancer, patients with breast cancer, patients with lung cancer.

So first of all, congratulations again. And please tell us about your study. Why did you do that? And what did you find? So let's start with the reason why did you do this study.

Chadi Hage Chehade: Yeah, thank you so much, Dr. Agarwal. It's truly an honor and a pleasure to be here. So just as a small background, as we all know, breast, prostate, and other cancers are among the most frequent advanced or metastatic neoplasms in the United States, where currently, multiple life-prolonging targeted therapies are approved for the treatment of these cancers, based on the results of NGS testing, as you mentioned.

So in this abstract, our hypothesis was that, in real-world settings, many patients with these cancers do not undergo next-generation sequencing, or NGS testing. And sometimes, when they do, it frequently occurs late in the disease course, at a point when the potential benefit of initiating new treatments could be a little bit limited. So in this abstract, we assess the overall utilization and the timing of NGS testing in relation to the time of death in a large patient-level data set.

Neeraj Agarwal: So these are the patients who have targetable therapies approved, based on underlying genomic mutations. So what were the disease types, to begin with, and what was the percentage, like proportion of testing? How many patients were getting tested among these patients?

Chadi Hage Chehade: Yeah, that's a great question. So in this study, we utilized the nationwide, de-identified Flatiron Health database, which collects data from around 800 sites of care all around the states. And the patients that were included in our study were patients with advanced or metastatic breast, prostate, non-small cell lung, colorectal, and pancreatic cancers. So we looked at these patients, and we wanted to see if they received NGS testing.

And the time between their first NGS results and the time of death was assessed. And patients were categorized into three groups. So first of all, patients who received their first NGS results more than three months before death. Second, patients who received their NGS results within three months of death. And the third category was patients who received their first NGS results after their death.

So now, looking at the results of our study, we found that in these five most common cancers in the US, where targeted therapies are approved based on the results of NGS testing, most patients do not undergo NGS. And the rates of testing range between 30% to 40%, with some differences based on the types of the different cancers.

And in the second part of our study, we wanted to assess the timing of NGS testing in relation to the time of death. And we focused only on patients who received NGS testing and had a date of death recorded. And what we found was that many patients received their first NGS results very late in the disease course.

And to go a little bit more into the details, around 13% to 26% of the patients received their first NGS results within three months of death. And even in 1% to 2% of cases, the results of the first NGS were reported after the death of the patients.

Neeraj Agarwal: So about 50% of patients with these common cancers are not undergoing NGS testing, is that correct?

Chadi Hage Chehade: Yes. A little bit more than 50% also.

Neeraj Agarwal: So even though they have life-prolonging therapies approved, they are not undergoing NGS testing in the United States. And you are also showing that in many of these patients, NGS testing, even if it is being done, it's done quite late during the course of disease, where they may not benefit with those therapies which may be available.

Maybe next step should be to see how many patients are actually getting these therapies in a timely fashion, where NGS testing is being done very late. And it's very unfortunate to see that in 1% to 2% of these patients, NGS testing was reported after death, meaning it was probably ordered as a desperation measure when patients were talking about hospice. That's the only reason why NGS testing would be reported after death, which is also very unfortunate.

So based on your experience, and of course, shout out to the Flatiron database, because of which this research was made possible, what is the next step? What should we be doing to allow our patients with these common cancers to get NGS testing in a timely fashion? What is the first step?

Chadi Hage Chehade: Yeah, that's a great question, Dr. Agarwal. And I would say that the first step would, first of all, to improve the utilization of NGS testing in real-world settings. And I believe that this can be achieved only through both patient- as well as physician-centered approaches and directives. For example, it's very important to enhance patient education, enhance access to genetic counseling in order to enhance access to genetic testing.

And there are multiple health care policies that should be implemented to increase not only access to NGS testing, but also in a timely fashion. So early in the disease course, when patients have a better performance status, they can better tolerate these life-prolonging targeted therapies, and that can improve their survival outcomes.

And some policies have already been established and underway. For example, in 2018, Medicare released the National Coverage Determination Memorandum for patients with advanced or metastatic cancers, which considered NGS as an essential diagnostic tool in the Centers for Medicare & Medicaid. And we saw that after the implementation of these policies, the rates of NGS testing slightly improved across all cancer types. But of course, further efforts are needed to improve these rates.

Neeraj Agarwal: Fantastic points. Well, congratulations again for your oral presentation at the ASCO 2025 meeting. And thanks for being here.

Chadi Hage Chehade: Thank you so much, Dr. Agarwal, for the invitation. I appreciate being here, talking about this study with you.