Real-world time to treatment initiation among NGS tested versus untested patients with metastatic lung or colorectal cancer.

199 Background: Next-generation sequencing (NGS) is becoming crucial for timely cancer treatment initiation with targeted therapies. This study compared real-world time to treatment initiation (rwTTT) among NGS tested versus untested metastatic non-small cell lung cancer (NSCLC) or colorectal cancer (CRC) patients, by social determinants of health (SDOH) indices. Methods: This retrospective study analyzed metastatic NSCLC or CRC patients from Jul 2016 to Oct 2022 in Optum’s claims data; the first date of metastasis was the index date. NGS tested and untested cohorts were balanced with inverse probability of treatment weights within each cancer. Cohorts were stratified by 5 SDOH domains: financial security, housing security, food security, social isolation and transportation access. rwTTT (i.e. days from index date to first-line treatment) was assessed with Kaplan-Meier analysis. Results: A total of 13,468 patients with NSCLC (46.2% were NGS tested) and 7,565 patients with CRC (35.5% were NGS tested) were included. The median times to NGS testing were 14 and 16 days in NSCLC and CRC cohorts, respectively. Across both cancers, NGS tested cohorts had significantly shorter rwTTT compared with untested patients, with ≥50% of the tested patients initiating treatment within 6 weeks. NGS tested patients also initiated their treatment earlier than untested patients across all the SDOH domains. Patients with low unmet need across all SDOH domains initiated treatment earlier relative to those with high unmet need across both cancers at 90 days of follow-up (Table 1); these trends remained consistent at subsequent follow-up time points (data not shown). Conclusions: NGS tested NSCLC and CRC patients initiated their treatment earlier relative to untested patients. Low unmet need of SDOH across most domains promote treatment initiation in both cancers. Further research is needed to understand the impact of NGS testing and subsequent timely initiation of targeted treatment on clinical outcomes. Time to treatment initiation in NSCLC and CRC. NSCLCNGS tested(N = 6,221) NSCLCUntested(N = 7,247) CRCNGS tested(N = 2,684) CRCUntested(N = 4,881) Overall; median (95% CI) weeks 6 (5.9 – 6.1) Not reached 5.4 (5.1 – 5.9) Not reached SDOH Domains, levels of unmet need; % initiating treatment at 90 days of follow-up Financial security: Low/ moderate /high 77.1%/ 73.3%/ 70.5% 30.5%/ 28.4%/ 27.9% 79.7%/ 79.6%/ 66.5% 25.2%/ 29.7%/ 23.5% Housing security: Low/ moderate /high 77.4%/ 73.3%/ 69.2% 31.4%/ 30.6%/ 28.1% 82.0%/ 76.2%/ 69.9% 28.3%/ 28.7%/ 19.4% Food security: Low/ moderate /high 74.8%/ 72.8%/ 72.8% 27.4%/ 29.3%/ 31.6% 77.4%/ 78.9%/ 71.6% 25.8%/ 28.9%/ 24.9% Social isolation: Low/ moderate /high 76.4%/ 73.4%/ 71.4% 32.6%/ 28.3%/ 24.8% 82.3%/ 74.9%/ 73.6% 27.8%/ 27.2%/ 25.6% Transportation access: Low/ moderate /high 77.2%/ 72.4%/ 68.3% 29.0%/ 27.3%/ 26.1% 78.7%/ 70.6%/ 67.6% 23.6%/ 27.5%/ 18.6%