Next-Generation Sequencing Trends Across Tumor Types

Use of next-generation sequencing increased between 2018 and 2022 among patients with metastatic breast cancer, metastatic prostate cancer, advanced non-small cell lung cancer, metastatic colorectal cancer, and metastatic pancreatic cancer. Even so, most patients did not undergo testing. After advanced or metastatic diagnosis, next-generation sequencing was received by 34.5% of patients with metastatic breast cancer, 44.5% of those with metastatic prostate cancer, 61.4% of those with advanced non-small cell lung cancer, 62.9% of those with metastatic colorectal cancer, and 51.2% of those with metastatic pancreatic cancer.

The cohort included 63,294 patients treated across US cancer clinics and sites of care. Median time to testing also varied by tumor type, ranging from less than 1 month in advanced non-small cell lung cancer to 11.0 months in metastatic prostate cancer. One-year cumulative incidence of next-generation sequencing was higher in patients diagnosed in 2022 than in those diagnosed in 2018 across all five tumor groups, suggesting broader adoption over time.

Disparities in Access to Genomic Testing

Despite these gains, the study found persistent disparities in time to next-generation sequencing. Lower socioeconomic status was associated with significantly longer time to testing in metastatic breast cancer, advanced non-small cell lung cancer, and metastatic colorectal cancer. Black patients experienced delays in advanced non-small cell lung cancer, metastatic colorectal cancer, and metastatic pancreatic cancer, while Hispanic patients had longer time to testing in metastatic breast cancer, metastatic prostate cancer, and metastatic colorectal cancer.

Insurance status was also associated with delayed access. Medicare or other government coverage was linked to longer time to next-generation sequencing in metastatic breast cancer, advanced non-small cell lung cancer, metastatic colorectal cancer, and metastatic pancreatic cancer, while Medicaid coverage was associated with delay in metastatic prostate cancer. The authors also observed significant interactions between socioeconomic status and insurance type in metastatic prostate cancer and advanced non-small cell lung cancer.

Bar Chart and Survival Curve Showing Cumulative Incidence by Cancer Type
After the Onset of Advanced or Metastatic Disease Diagnosis

Cumulative incidence of testing after advanced or metastatic disease diagnosis by cancer type. 

Implications for Precision Oncology

The findings indicate that next-generation sequencing adoption has improved, but equitable access remains incomplete. Because genomic profiling can identify actionable alterations and inform targeted treatment selection, delayed or absent testing may limit timely use of precision oncology strategies. The authors conclude that these benchmark data should inform policy and educational efforts designed to reduce underuse of next-generation sequencing and close persistent access gaps across common advanced cancers.

Source – American Medical Journal