Study Finds Genomic Profiling Turnaround Time Improves, but Delays Persist

According to a retrospective analysis, median turnaround time for tissue-based comprehensive genomic profiling (CGP) declined between 2018 and 2024, though substantial variation across clinical sites remains a barrier to timely biomarker-driven treatment decisions.¹ The study, published in JCO Oncology Practice, was designed to generate generalizable estimates of turnaround time for tissue-based CGP and to identify trends over time as well as clinical, demographic, and administrative factors associated with delays.

Investigators analyzed data from 271,574 specimen samples originating from 5497 clinical sites across the United States on which tissue-based CGP (FoundationOne CDx) had been successfully completed between 2018 and 2024. Descriptive statistics were used to summarize and compare turnaround time between sites, and linear regression was used to assess yearly trends and associations between turnaround time and clinical, demographic, and administrative variables.

Key Findings: Improved Overall TAT, Slow Ordering TAT

Across all cancer types, median turnaround time declined from 43 days (IQR, 31-72) in 2018 to 32 days (IQR, 22-51) in 2024. Non–small cell lung cancer (NSCLC) samples had the shortest turnaround time of any cancer type evaluated.

However, substantial site-level variation persisted despite the overall downward trend. Among all tumor types, the fastest quintile of clinical sites had a median turnaround time of 23.1 days (IQR, 20.6-24.6) compared with 46.5 days (IQR, 42.7-50.8) in the slowest quintile (P <.001). For NSCLC specifically, the fastest quintile of sites had a median turnaround time of 19.5 days (IQR, 16.7-20.6) compared with 38.9 days (IQR, 35.3-41.8) in the slowest quintile (P <.001).

Notably, the interval between biopsy and CGP order placement—rather than laboratory processing time—was identified as the largest contributor to prolonged overall turnaround time, showing no improvement over the time period. Median time from biopsy to test ordering across all samples ranged from 10 days (IQR, 8-12) in the fastest quintile of sites to 30.8 days (IQR, 26.6-35) in the slowest quintile. Among NSCLC samples specifically, this interval ranged from 8 days (IQR, 6.8-9.1) in the fastest quintile to 23.8 days (IQR, 21-28.3) in the slowest quintile (P <.001).

Limitations and Clinical Implications

The findings suggest that efforts to reduce delays in molecular testing should focus on the preanalytic period between biopsy and test ordering rather than solely on laboratory or sequencing turnaround, since this interval was found to be the predominant driver of overall delay.

“Our data show that lack of timeliness in ordering after diagnosis represents a clinically meaningful delay in testing that likely further leads to delays in appropriate treatment,” authors Fox et al concluded.

Given that timely biomarker results are central to first-line treatment selection in NSCLC and other advanced solid tumors, current guidance from the American Society of Clinical Oncology (ASCO) recommends that biomarker results be available at the time of treatment decision-making.² Closing these gaps, particularly at sites in the slower-performing quintiles, may therefore help ensure more patients receive molecularly guided therapy without unnecessary delay.

The authors encouraged multidisciplinary oncology teams—including those involved in obtaining biopsies and those interpreting molecular results—to examine site-level data and identify opportunities to streamline ordering workflows.

Of note, the study was retrospective and derived from a single commercial reference laboratory database, which the authors noted should be considered when generalizing findings across other testing platforms or institutional workflows.

REFERENCES

1. Fox AH, Keller-Evans RB, Huang RSP, Silvestri GA. Turnaround Time of Comprehensive Genomic Profiling in Lung Cancer and Other Solid Tumors. JCO Oncol Prac. Published online June 18, 2026. doi:10.1200/op-25-01191

2. Reuss JE, Ismaila N, Ahluwalia A, et al. Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, 2026.3.1. J Clin Oncol. 2026;44(18):e89-e100. doi:10.1200/JCO-26-00843