Molecular profiling of advanced malignancies: A community oncology network experience.

Abstract

e23111 Background: Many genomic alterations have been identified that are critical to the malignant phenotype. Some of these, termed “driver mutations”, are critical for tumor proliferation and progression. The landscape of targeted therapy has expanded as well. Next-generation sequencing (NGS) of tumors reveals cancer-related genomic alterations and provides therapeutic recommendations for specific targeted therapy. We analyzed our experience with FoundationOne, a validated NGS genomic profile in a community oncology network. Methods: NGS results from May 2014 to September 2016 from a community oncology network in Western Pennsylvania were analyzed. Medical records were reviewed for primary site, stage, biopsy site, timing of testing, prior treatment, FDA-approved therapy in patient’s and other tumor types and potential clinical trials based upon mutations detected. Endpoints determined were percentage of patients with targetable mutations and those in whom treatment decisions were made based on NGS results. Results: 157 NGS results were available for analysis. 38.2% cases were tested early in the disease course (at diagnosis, during or shortly after first-line treatment) and 61.8% at progression. FDA-approved targeted agent for a specific mutation was found in 14% of the primary tumor type and 19.8% of other tumor types. Clinical trials were available for 93% cases. The NGS results were utilized in treatment decisions in 28 patients of which, 9 were tested early and 19 at disease progression. Of the 28, 11 were initiated on a targeted agent. Median duration of targeted therapy was 2.6 months. 9 patients were on appropriate targeted agent prior to testing. 8 patients were unable to start the targeted agent because of insurance denial, clinical deterioration or patient preference. Conclusions: NGS is a valuable tool for personalizing cancer care. From our experience, the actual number of patients starting a targeted agent based on NGS results is low. It nevertheless can provide additional treatment options and facilitate clinical trial enrollment. Optimal timing of testing (early vs late), financial implications of testing and using targeted therapy and survival benefit of targeted therapy need further studies.