Oncologist uptake of comprehensive genomic profile guided targeted therapy

Abstract

We describe the extent to which comprehensive genomic profiling (CGP) results were used by oncologists to guide targeted therapy selection in a cohort of solid tumor patients tested as part of standard care at Roswell Park Comprehensive Cancer Center June 2016–June 2017, with adequate follow up through September 2018 ( n = 620). Overall, 28.4% of CGP tests advised physicians about targeted therapy use supported by companion diagnostic or practice guideline evidence. Post-test targeted therapy uptake was highest for patients in active treatment at the time of order (86% versus 76% of treatment naïve patients), but also took longer to initiate (median 50 days versus 7 days for treatment naïve patients), with few patients (2.6%) receiving targeted agents prior to testing. 100% of patients with resistance variants did not receive targeted agents. Treatment naïve patients received immunotherapy as the most common alternative. When targeted therapy given off-label or in a trial was the best CGP option, (7%) of patients received it. Our data illustrate the appropriate and heterogeneous use of CGP by oncologists as a longitudinal treatment decision tool based on patient history and treatment needs, and that some patients may benefit from testing prior to initiation of other standard treatments.

Feasibility of next-generation sequencing in clinical practice: results of a pilot study in the Department of Precision Medicine at the University of Campania ‘Luigi Vanvitelli’

“…[9][10][11][12] Considering the time of follow-up of our study (in most of patients F1CDx was performed in the last 6 months of the study), and the fact that many patients did not progress to their ongoing therapies, probably we will reach this percentage during next years. Indeed, a good number of prospective [17][18][19][20][21][22][23] and retrospective [24][25][26][27] trials evaluated CGP using different techniques (NGS, WES, WGS) but in the context of large academic centres. Largest prospective study defined the potential and the limitations of extensive genomic panel (SHIVA, 17 NCI-MATCH, 18 NCI-MPACT, 19 ASCO-TAPUR, 20 I-PREDICT, 21 WINTHER, 22 PROFILER.…”

Impact and Diagnostic Gaps of Comprehensive Genomic Profiling in Real-World Clinical Practice

“…Despite guidelines, the uptake of CGP in the community has not been uniform, even in NSCLC patients and the general impact of CGP as to patient outcomes and cost effectiveness remains unclear [13,14]. A large retrospective study of advanced NSCLC patients treated in the community setting identified gaps in national guideline based genomic testing for EGFR and ALK [4].…”

A Narrative Review of Implementing Precision Oncology in Metastatic Castration-Resistant Prostate Cancer in Emerging Countries

“… Ability of both clinicians and molecular pathologists to be/keep up to date with the rapidly changing treatment landscape . Interpreting molecular results will require the expertise of molecular pathologists and geneticists [ 64 ]. While molecular tumor boards [ 65 ] are becoming more established in the Western world, they remain an uncommon phenomenon in emerging countries.…”