Molecular testing patterns and implications for treatment at a cancer center.

Abstract

e13576 Background: Genetic testing has revolutionized the care of ovarian cancer, providing a potential for targeted therapies and cancer prevention through cascade testing. Previous historical control for genetic testing rate of 28.5% at our institution, this initiated a multilevel intervention to improve guideline concordant care. The main objective of this study is a descriptive analysis of genetic testing patterns with the implementation of a genetics tumor board (GTB) at an NCI comprehensive cancer center (CCC). Methods: All gynecologic oncology cancer patients who underwent somatic testing from 3/2019 to 1/2020 were included in gynecologic oncology GTB. A descriptive analysis was performed on the ovarian cancer patients. Information regarding patient demographics, cancer characteristics, treatment, and follow-up were obtained from the medical records. Results: There were a total of 81 patients included in GTB during this time period. Fifty-four of 81 (66.7%) received care at our CCC and 27 of 81 (33.3%) were seen as a second opinion case. The patients included in GTB were comprised of recurrent ovarian cancer cases and newly diagnosed ovarian cancer cases. Of the patients included in genetics tumor board, 58 of 81 (71.6%) of patients received both germline and somatic testing. Genetics referrals were placed for 16 of 23 (69%) of the patients who received somatic testing without subsequent germline testing. Twelve of 81 (14.8%) GTB patients were identified for clinical trials during this time period. Conclusions: Genetic testing has become a cornerstone to ovarian cancer care. Implementation of a genetics tumor board at our institution has increased rates of germline testing compared to historical controls. With genetic tumor board being made up of a third of patients seeking a second opinion, we are able to provide comprehensive care to such patients in the form of genetic counseling referrals and clinical trial opportunities. Genetics tumor board also appears to highlight the cohort of patients with the most aggressive cancers: high-grade, advanced stage, and high rates of recurrence. This can potentially improve care by providing an arena for a multidisciplinary discussion of our most complex patients. Ongoing studies with the implementation of our cancer pathways may help determine which modifiable factors can be targeted to help increase adherence to genetic testing recommendations as we continue to strive for guideline-based care.