ESMO18: Precision oncology is increasingly being utilized in community care settings

A recent study of patients with advanced cancer being treated at National Comprehensive Cancer Network centers in the USA has explored the degree to which comprehensive genomic profiling  (CGP) – led precision oncology are utilized in community care. Ricardo Alvarez (Cancer Treatment Centers of America (CTCA), GA, USA) and colleagues (CTCA and Foundation Medicine, MA, USA) discovered that 23% of these patients received DNA matched treatment, compared with a figure of 11% reported in previous studies. 

Of the 6177 patients who underwent CGP, genomic alterations were discovered in 94%, 47% of which were considered to be clinically significant. The most frequent DNA changes of these were in the KRAS (23%) and PIK3CA (15%) genes, and the most common alterations were gene amplifications (32%).

Of the 23% treated with DNA matched drugs, 57% received therapies approved for different cancers by the US FDA and 15% enrolled in clinical trials.

“We have shown that we can perform large-scale tumor profiling and use the results to match patients to targeted treatment in the type of community setting where most patients are treated in the United States,” explained Alvarez.

Joaquin Mateo (Prostate Cancer Translational Research Group, Vall d’Hebrón Institute of Oncology, Barcelona, Spain), lead author of a recent paper on the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT) commented: “This is an important study because of the large number of patients and what it tells us about the impact of genomic research on patient care and clinical decisions in the community where the majority of patients are treated. Studies like this are building the evidence we need to implement precision medicine within the oncology community and offer it more widely to our patients.”

Mateo went on to express concern regarding the cost of DNA testing whereby only a quarter of patients stand to gain benefit, while also emphasizing the importance of developing standardized criteria to engender higher levels of confidence and robustness in matching targeted treatments. He indicated that he was hopeful that ESCAT, which grades alterations in tumor DNA in accordance with the clinical evidence supporting their use as markers for targeted treatment, may be adopted to further this purpose.

Looking to the implications of the study, Ricardo Alvarez commented: “In the next few years, we hope that as many as 50% of our patients will receive matched treatment through clinical trials or off-label treatment with approved medicines. It is so encouraging to see how precision medicine is changing the way we treat our patients in the community and our next step is to analyze the effects of targeted treatment on survival and quality of life.”

Sources: Alvarez RH et al.  Mutational landscape of metastatic cancers discovered from prospective clinical sequencing at community practice cancer program. Annals Oncol. 29 (Suppl. 8) (2018);