Abstract
Oncology has become more reliant on new testing methods and a greater use of electronic medical records, which provide a plethora of information available to physicians and researchers. However, to take advantage of vital clinical and research data for precision medicine, we must initially make an effort to create an infrastructure for the collection, storage, and utilization of this information with uniquely designed disease-specific registries that could support the collection of a large number of patients. In this study, we perform an in-depth analysis of a series of lung adenocarcinoma patients (n = 415) with genomic and clinical data in a recently created thoracic patient registry. Of the 415 patients with lung adenocarcinoma, 59% (n = 245) were female; the median age was 64 (range, 22-92) years with a median OS of 33.29 months (95% CI, 29.77-39.48). The most common actionable alterations were identified in EGFR (n = 177/415 [42.7%]), ALK (n = 28/377 [7.4%]), and BRAF V600E (n = 7/288 [2.4%]). There was also a discernible difference in survival for 222 patients, who had an actionable alteration, with a median OS of 39.8 months as compared to 193 wild-type patients with a median OS of 26.0 months (P<0.001). We identified an unprecedented number of actionable alterations [53.5% (222/415)], including distinct individual alteration rates, as compared with 15.0% and 22.3% in TCGA and GENIE respectively. The use of patient registries, focused genomic panels and the appropriate use of clinical guidelines in community and academic settings may influence cohort selection for clinical trials and improve survival outcomes.
Highlights
In response to advances in genomic testing and the rapid integration of new drugs and publications, oncologists have been adapting the concept of precision medicine where evidencebased medicine guides treatment decisions for individuals [1]
Of the 415 patients with lung adenocarcinoma, 59% (n = 245) were female; the median age was 64 years with a median overall survival (OS) of 33.29 months
We identified an unprecedented number of actionable alterations [53.5% (222/ 415)], including distinct individual alteration rates, as compared with 15.0% and 22.3% in TCGA and GENIE respectively
Summary
In response to advances in genomic testing and the rapid integration of new drugs and publications, oncologists have been adapting the concept of precision medicine where evidencebased medicine guides treatment decisions for individuals [1]. In this pursuit, several organizations have implemented the utilization of guidelines and pathways to ensure that patients receive proper testing and are assigned to proper treatment options, which in theory should translate into durable survival outcomes [2,3,4,5,6] This spur towards personalized medicine is primarily driven by the advances in genomic testing, biomarkerdriven therapy, and immunotherapy that have transformed the landscape of oncology care and have greatly improved outcomes for patients [7,8,9,10,11,12]. The application of molecular testing is transforming cancer into a diverse template of genomic alterations that drive oncogenesis [13]
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