Fact checked byHeather Biele

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July 02, 2025
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Most patients with advanced cancer do not undergo next-generation sequencing testing

Fact checked byHeather Biele

Key takeaways:

  • Real-world data show that only about 30% to 40% of patients with the most common cancers receive NGS testing.
  • Among those who do receive testing, a substantial number receive results within 3 months of death.

CHICAGO — The majority of patients with the most common advanced or metastatic cancers in the United States do not undergo next-generation sequencing testing, according to study results presented at ASCO Annual Meeting.

Data also showed that of those who did undergo testing over the past decade, up to about 25% received results late in their disease course — specifically, within 3 months of death.

Patients with common neoplasms who received NGS testing infographic
Data derived from Chehade CH, et al. Abstract 11014. Presented at: ASCO Annual Meeting; May 30-June 3, 2025; Chicago.

“Next-generation sequencing has defined a new era of personalized approaches in the treatment of patients with cancer, as it allows clinicians to uncover mutations which can be predicative of targeted therapies that are associated with survival outcomes,” Chadi Hage Chehade, MD, a postdoctoral research fellow at Huntsman Cancer Institute at University of Utah, told Healio.

“Previous work found significantly low uptake of next-generation sequencing testing for patients with metastatic prostate and urothelial cancers,” he added. “We wanted to expand our initial work to include the five most common cancers.”

Initial hypothesis

Non-small cell lung cancer, breast cancer, prostate cancer, colorectal cancer and pancreatic cancer are the most prevalent advanced or metastatic neoplasms in the United States.

Current guidelines recommend next-generation sequencing testing (NGS) to identify tumor susceptible alterations, for which targeted therapies are available and approved, according to study background.

Chehade and colleagues conducted a retrospective study to assess overall utilization of NGS and timing of the testing in relation to time of death.

“Our hypothesis was that in real-world setting, patients may not have access to NGS testing,” Chehade told Healio. “We also hypothesized that when patients are receiving testing, it may happen very late into the disease course.”

Researchers used the Flatiron Health electronic health record-derived database to identify patients with one of the five cancer types — all of whom had information on receipt of NGS and a recorded date of death — from 280 cancer clinics. Data collection began in 2011.

They measured time between the first NGS result and date of death, and categorized patients into three groups, based on receipt of results — more than 3 months before death, within 3 months of death or after death.

Surprising results

The researchers identified 86,536 patients with advanced non-small cell lung cancer, 36,000 with metastatic breast cancer, 35,702 with advanced colorectal cancer, 24,105 with metastatic prostate cancer and 14,964 with metastatic pancreatic cancer.

About a third of patients from each cancer group received NGS testing (NSCLC, 36.3%; breast cancer, 32.1%; colorectal cancer, 41%; prostate cancer, 30.9%; and pancreatic cancer, 35.4%).

Analysis included only those patients who received testing and had a recorded date of death (NSCLC, 23.1%; breast cancer, 15.8%; colorectal cancer, 24%; prostate cancer, 14.1%; and pancreatic cancer, 26.4%).

Data showed that most patients received NGS testing more than 3 months before death (NSCLC, 72.3%; breast cancer, 81.6%; colorectal cancer, 85%; prostate cancer, 85.4%; and pancreatic cancer, 71.1%).

However, about a quarter of patients with NSCLC (25.6%) and pancreatic cancer (26.5%) received results within 3 months of death, with lower rates reported for breast cancer (16.9%), colorectal cancer (13.7%) and prostate cancer (13.5%).

Between 1.1% and 2.4% of patients had NGS results reported after death.

“These results were very surprising to us given the multiple life-prolonging targeted therapies that are currently approved,” Chehade told Healio. “These findings show that many patients are receiving their first NGS testing at the end of their life and do not benefit from the targeted therapies they may have received earlier in the course of their disease.”

Despite this, Chehade noted that rates of patients receiving NGS testing more than 3 months before death have increased over the past decade, while rates of receipt within 3 months of death have decreased.

Researchers acknowledged study limitations, including its retrospective real-world design, data missing from certain endpoints due to reliance on EHRs and inability to account for potential biases or changes in patient characteristics over time.

“The ultimate goal would be for all patients to receive NGS testing earlier in their disease course, so they are able to receive the targeted therapies earlier and tolerate the therapies better,” Chehade said. “Otherwise, we’re depriving them of therapies that could improve and prolong their survival.”

He added, “The next steps for our work would be to better understand the gaps in the current rates of NGS testing to understand why this is happening and why patients may receive testing late in their disease course.”

For more information:

Chadi Hage Chehade, MD, can be reached at chadi.chehade@hci.utah.edu.