Assessment of genomic profiling in patients with colorectal cancer treated in community oncology practices.

Abstract

e15538 Background: Comprehensive genomic profiling is becoming the standard of care for oncology, though actionable biomarkers remain the focus. The value of expansion from single gene tests to large, next-generation sequencing (NGS) based tests can be seen in the application of precision medicine. Additionally, circulating tumor DNA (ctDNA) is becoming a key area of testing during and post treatment. In this study, we explored genetic testing rates in colorectal cancer (CRC) patients (pts). Methods: Pts were identified from the iKnowMedSM EMR data over 4 years (2018-2022) from 113 community oncology practices. Pts were required to have either primary colon or rectal cancer, be at least 20 yrs old at diagnosis, and have at least 2 office visits. All stages of disease were included. Genomic data was assessed from two sources: abstracted data from charts and genomics reports from clinical labs. Genomic tests included detection of mutations for relevant biomarkers, including but not limited to BRAF, KRAS, NRAS, NTRK, microsatellite instability (MSI), and tumor mutational burden (TMB), and entry of germline biomarkers relevant to Lynch syndrome. The use of ctDNA was also evaluated. Results: A cohort of 41,980 pts with CRC was identified. Median age was 66 yrs, 62% white. Of these, 18,782 pts (45%) had biomarker testing performed. Genomic testing rates were observed to have increased by 61% across all stages of disease over the four-year time span. The highest rate of biomarker testing was performed in pts with stage IV disease at diagnosis, representing 21% (n = 9021). Testing results were most often available for BRAF (n = 17576), with nearly 16% of the cohort showing a mutation, 35% of those with the V600E mutation (n = 967). MSI was observed in 14%. Increasing use of ctDNA observed, and 350 pts had multiple genetic reports (3+). Of the pts with genetic information, 245 were enrolled in clinical trials. Conclusions: In this study, we observed the increase of genetic profiling of CRC pts over time. Additional research into the use of targeted therapies and outcomes will be performed. The exploratory regions of the NGS-based assays tested may also provide new potential targets as the database of combined clinical and genetic information grows.