Utility of next generation sequencing (NGS) in advanced malignancies in a community hospital in an underserved area: A game changer?

Abstract

e15037 Background: Next Generation Sequencing (NGS) is a revolutionary test used in advanced malignancies to study specific mutations, define tumor burdens, & design personalized treatment plans based on the target mutations. With this study, our aim is to highlight the role of NGS, especially in a community hospital & emphasize on its implementation as a standard of care in advanced metastatic cancers. Methods: We retrospectively reviewed the charts of 51 patients after IRB approval, aged > 18 years with no specific demographic restrictions, with advanced malignancies who had NGS at Mercy Catholic Medical Center, PA. Results: Of 51 patients, 25 were males & 26 were females, 44 patients had positive results on NGS. 100 types of mutations were identified & 338 mutations in total were found. Lung cancer had highest mutations (41.17%-21/51), followed by colon (25.49% - 13/51), breast, ovarian & endometrium (13.72% 7/51), & the rest comprised of GI malignancies & prostate cancers. Of 100 mutations, 32% (32/100) had actionable targets & received NGS directed chemoimmunotherapy, 22% (22/100) mutations had experimental chemo-immunotherapeutic drugs, & 49% (49/100) had no specific NGS directed therapy actionable/target mutation. The most common (1,2,3) & some rare mutations (4,5 and 6) with directed immunotherapy noted on NGS are listed in Table 1. Conclusions: As per our study, 86.27% of the sample size showed positive results on NGS. 32% of these mutations had NGS directed chemoimmunotherapy against these target mutations. In contrary to standard treatment regimens, a personalized treatment plan was developed for these patients, thereby curbing further progression & improving survival in patients with advanced cancer. For example, a patient with stage IV colon cancer who was progressing on the standard treatment with FOLFOX (Folinic acid, flurouracil and oxaliplatin), was started on Ivosedenib, after undergoing NGS and showed marked improvement clinically and radiologically. 29 out of 43 guidelines for various malignancies established by National Comprehensive Cancer Network highlight the significance of NGS. With this study, our goal is to emphasize on the utility of NGS in patients with advanced cancer & the need for it to be incorporated as the standard of care, in small & mid-tier community hospitals, which would need a devised plan for its implementation. [Table: see text]