Oncologist use and perception of large panel next-generation tumor sequencing

被引:31
作者
Schram, A. M. [1 ]
Reales, D. [2 ]
Galle, J. [2 ]
Cambria, R. [2 ]
Durany, R. [3 ]
Feldman, D. [1 ,4 ]
Sherman, E. [1 ,4 ]
Rosenberg, J. [1 ,4 ]
D'Andrea, G. [1 ,4 ]
Baxi, S. [1 ,4 ]
Janjigian, Y. [1 ,4 ]
Tap, W. [1 ,4 ]
Dickler, M. [1 ,4 ]
Baselga, J. [1 ,4 ,5 ,6 ]
Taylor, B. S. [5 ,6 ,7 ]
Chakravarty, D. [6 ]
Gao, J. [6 ]
Schultz, N. [6 ,7 ]
Solit, D. B. [1 ,4 ,5 ,6 ]
Berger, M. F. [6 ,8 ]
Hyman, D. M. [1 ,4 ]
机构
[1] MSKCC, Dept Med, Div Solid Tumor Oncol, New York, NY USA
[2] MSKCC, Clin Res Adm, New York, NY USA
[3] MSKCC, Josie Robertson Surg Ctr, New York, NY USA
[4] Weill Cornell Med Coll, New York, NY USA
[5] MSKCC, Human Oncol & Pathogenesis Program, New York, NY USA
[6] MSKCC, Marie Jose & Henry R Kravis Ctr Mol Oncol, New York, NY USA
[7] MSKCC, Dept Epidemiol & Biostat, New York, NY USA
[8] MSKCC, Dept Pathol, New York, NY USA
基金
美国国家卫生研究院;
关键词
precision medicine; targeted therapy; tumor sequencing; next-generation sequencing; MATCHED CLINICAL-TRIALS; CANCER;
D O I
10.1093/annonc/mdx294
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Genomic profiling is increasingly incorporated into oncology research and the clinical care of cancer patients. We sought to determine physician perception and use of enterprise-scale clinical sequencing at our center, including whether testing changed management and the reasoning behind this decision-making. Patients and methods: All physicians who consented patients to MSK-IMPACT, a next-generation hybridization capture assay, in tumor types where molecular profiling is not routinely performed were asked to complete a questionnaire for each patient. Physician determination of genomic 'actionability' was compared to an expertly curated knowledgebase of somatic variants. Reported management decisions were compared to chart review. Results: Responses were received from 146 physicians pertaining to 1932 patients diagnosed with 1 of 49 cancer types. Physicians indicated that sequencing altered management in 21% (331/1593) of patients in need of a treatment change. Among those in whom treatment was not altered, physicians indicated the presence of an actionable alteration in 55% (805/1474), however, only 45% (362/805) of these cases had a genomic variant annotated as actionable by expert curators. Further evaluation of these patients revealed that 66% (291/443) had a variant in a gene associated with biologic but not clinical evidence of actionability or a variant of unknown significance in a gene with at least one known actionable alteration. Of the cases annotated as actionable by experts, physicians identified an actionable alteration in 81% (362/445). In total, 13% (245/1932) of patients were enrolled to a genomically matched trial. Conclusion: Although physician and expert assessment differed, clinicians demonstrate substantial awareness of the genes associated with potential actionability and report using this knowledge to inform management in one in five patients.
引用
收藏
页码:2298 / 2304
页数:7
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