The Impact of Molecular Testing and Therapy for Gynecologic Cancers in Low Resource Environments [31D]

Abstract

INTRODUCTION: Targeted cancer therapies based on tumor molecular analysis have grown exponentially in the last 5 years. Multiple gynecologic tumors can express markers that predict response to specific treatments. However not all insurance covers costly testing for every tumor marker, which can prevent un- or under-insured women from receiving optimal treatment. We worked with independent laboratories to provide free or cost-reduced testing. This study's aim is to demonstrate the impact of a universal molecular-based therapeutic program for gynecologic cancers in a low-resource environment. METHODS: Women with new gynecologic cancers presenting to an inner-city academic facility were identified between 1/1/18 and 6/30/18. Pedigree analysis and molecular testing of tumor specimens were done in all subjects. Data collected includes: demographics (including insurance status), tumor type and stage, and initial treatments. RESULTS: 45 women with gynecologic cancer were identified. (Cervix-18, Ovary-7, Uterus-10, Vulva/vagina-10). 5/18 cervix cancers showed Combined Predictive Score >1.0; 3/10 uterine cancers showed mismatch repair (MMR) deficiencies; 3/10 vulva/vagina showed MMR deficiencies; and 2/7 ovarian cancers showed somatic BRCA mutations. In this 6-month period, 13/45 (29%) of gynecologic malignancies diagnosed had molecular markers associated with targeted therapies, and 7/13 (53%) patients with predictive molecular markers accepted a targeted therapy. CONCLUSION: Molecular analysis of cancer with therapy based on molecular markers is the gold standard for gynecologic cancers. 29% of the subjects had molecular markers associated with targeted therapies. While molecular testing and targeted therapies may be expensive, many laboratories and pharmaceutical companies are willing to work with patients with limited resources.