Beyond Actionability: A Real-World Audit and Quality Improvement Initiative to Refine Shared Decision-Making Following 50-Gene Next-Generation Sequencing Results in Non-small Cell Lung Cancer.

Authors

Arun Krishnan M P, Vyshakh Thovarayi, Praveen K Shenoy, Nandini Devi R, Deepak Roshan

Published in

Cureus. Volume 18. Issue 8. Pages e115487. Epub Aug 31, 2026.

Abstract

Broad-panel next-generation sequencing (NGS) improves detection of clinically relevant genomic alterations beyond those detected by conventional targeted panels in advanced non-small cell lung cancer (NSCLC). However, the influence of these additional findings on shared decision-making (SDM) in routine clinical practice remains poorly described. This study evaluated the incremental value of an institutional 50-gene NGS panel in documenting SDM and characterized the genomic landscape in advanced NSCLC.
This retrospective observational study included consecutive patients with biopsy-proven advanced NSCLC who underwent in-house 50-gene NGS between June 2025 and June 2026 and had at least one documented post-NGS oncology consultation. Formalin-fixed paraffin-embedded tumor samples with ≥20% tumor cellularity were analyzed using an in-house 50-gene panel. Genomic alterations across all 50 genes were analyzed to characterize the molecular landscape, and alterations in the 37 genes exclusive to the expanded panel were evaluated for their impact on SDM. SDM was assessed across six predefined domains: targeted therapy discussion, molecular tumor board (MTB) referral, departmental discussion, clinical trial discussion, prognostic counseling, and genetic clinic referral.
A total of 113 patients were included (median age, 64.5 years; 74.3% males). The most frequent alterations in the 50-gene panel were TP53 (45.1%), KRAS (25.7%), EGFR (20.4%), CDKN2A (16.8%), FGFR3 (9.7%), and FGFR1 (7.1%). Additional genomic alterations exclusive to the expanded panel were identified in 49 patients (43.4%). However, only 16 patients (32.7%) had documented SDM influenced by these additional findings. Departmental discussion was the most frequently documented SDM domain (24.5%), whereas MTB referral (4.1%), targeted therapy discussion (4.1%), and clinical trial discussion (6.1%) were infrequent. No documented prognostic counseling or genetic referral was identified. A structured post-NGS SDM documentation template was developed.
Genomic profiling using a 50-gene NGS panel identified additional genomic alterations in patients with advanced NSCLC; however, documentation of the influence of these findings on SDM remained limited. Implementation of a standardized post-NGS documentation template may improve SDM documentation and facilitate more comprehensive integration of genomic findings into routine precision oncology practice.

PMID:
42819076
Bibliographic data and abstract were imported from PubMed on 02 Oct 2026.

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