In this issue of JAMA, Presley et al1 report the results of a case-cohort study of 5688 patients with advanced non–small cell lung cancer (NSCLC) based on data acquired through abstraction and aggregation of information from the electronic medical record (EMR) from 191 US community oncology practices.1 The focus of the study was whether a survival advantage was observed among patients who underwent broad-based genomic sequencing (defined as next-generation sequencing evaluating >30 cancer genes) compared with routine testing (defined as solely EGFR and ALK testing). Of the cohort, 875 patients received broad-based genomic sequencing and 4813 received routine testing. This study used an instrumental variable analysis that helps account for confounding variables, such as timing of testing compared with therapeutic line, comorbidities, socioeconomic factors, age, and sex, among others (although many important variables such as smoking and performance status were not available in the EMR).
Bunn PA, Aisner DL. Broad-Based Molecular Testing for Lung Cancer: Precisely the Time for Precision. JAMA. 2018;320(5):445–446. doi:10.1001/jama.2018.10096
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