CLO19-034: The Clinical Outcomes of Next-Generation Sequencing Testing at a Community Oncology Practice

Abstract

Background: The value of next-generation sequencing (NGS) tests is dependent on how it changes clinical management, if at all. There are not any guidelines on when a physician should obtain testing; what certain genetic variations can be clinically, meaningfully intervened on; and if this active drug is financially practical. A NGS test ideally should identify a targetable mutational profile that leads to a treatment that can be obtained and produces lasting responses. We reviewed the NGS testing practices at our community hospital. Methods: Patients in our oncology clinic that underwent NGS testing of their tumor were reviewed. Specifically, the patient’s age, gender, diagnosis, date of diagnosis, previous lines of treatment, date of NGS testing, and reported molecular targets were recorded. Details of the changes in clinical management based on the NGS and survival time after the NGS test was ordered were also analyzed. Results: Forty-three patient cases were reviewed that had NGS testing obtained between the years 2014–2015 and 2017. Eighteen patients were males and 25 were females. Median age was 60 years. Most common tumor type was breast; 3 were triple-negative and 6 were only hormone-receptor positive. Second most common type was colorectal. NGS changed management in 12 cases. Two patients were able to enter a clinical trial and the other 10 had therapeutic changes based on protein or mRNA overexpression. Median time of change in management to survival in these patients was 7 months. Thirty-seven patients died; overall time from ordering of test to death was 7 months. Overall time of ordering test to survival for all patients was 8 months. Conclusions: NGS gathers a significant amount of information of a patient’s cancer, but this information is difficult to interpret in the clinical setting. Twenty-eight percent of our patients had a change in treatment, but this did not translate into lasting responses compared to other patients. Furthermore, the responses that were seen may have not been related to the therapeutic interventions, but intrinsic tumor biology. It is important to be aware of the clinical utility in ordering these tests for both the physician and patient.

Medical oncologists’ perspectives of the Veterans Affairs National Precision Oncology Program

“…The concerns are secondary to the costs of tumor DNA sequencing despite limited evidence supporting its use. A few studies have evaluated the benefits of conducting multigene NGS panels in a widespread fashion [3][4][5][6]. A limited benefit has been identified in altering treatment patterns and identifying germline mutations.…”