在一家三级保健中心，肿瘤下一代测序面板检测对指导晚期实体瘤患者治疗决策的临床应用。

Clinical Utility of Tumor Next-Generation Sequencing Panel Testing to Inform Treatment Decisions for Patients With Advanced Solid Tumors in a Tertiary Care Center.

机构信息

Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.

Department of Medical Oncology, McGill University Health Centre, Montreal, Canada.

出版信息

JCO Precis Oncol. 2024 Jun;8:e2400092. doi: 10.1200/PO.24.00092.

DOI:10.1200/PO.24.00092

PMID:38935894

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11371095/

Abstract

PURPOSE

There is limited information about the clinical utility of targeted next-generation sequencing (NGS) panel testing to inform decision making for patients with advanced solid tumors. The Ontario-wide Cancer Targeted Nucleic Acid Evaluation (OCTANE) is a prospective study that enrolled more than 4,500 patients with solid tumor for NGS panel testing. We performed a retrospective survey of medical oncologists to evaluate the impact of NGS testing on treatment decisions.

METHODS

Patients and treating oncologists were identified at the Princess Margaret Cancer Center between 2016 and 2021. Tumor-only sequencing was performed using a gene panel of either 555 or 161 cancer genes. Oncologists were asked to review testing results and complete a survey indicating whether NGS testing affected treatment decisions. The primary outcome of this study was rate of treatment change on the basis of mutation results. Patient, test, and physician factors were evaluated for association with treatment changes using univariate analyses and a mixed-effects model.

RESULTS

Of the 582 surveys sent, 394 (67.7%) were completed. We found that 188 (47.7%) patients had testing results classified as actionable by the oncologist and 62 (15.7%) patients were matched to treatment, of whom 37 (60%) were enrolled in a clinical trial, 13 (21%) received an approved drug, four (6%) were prescribed off-label therapy, and eight (13%) avoided ineffective treatment. Patient, test, and physician characteristics were not significantly associated with treatment change. There was no difference in overall survival between patients who received matched treatment versus those who did not ( = .55, median survival not reached).

CONCLUSION

OCTANE testing led to a change in drug treatment in 15.7% of patients, supporting the clinical utility of NGS panel testing for patients with advanced solid tumors.

摘要

目的

关于靶向下一代测序（NGS）面板检测在为晚期实体瘤患者做出决策方面的临床应用价值，信息有限。安大略省癌症靶向核酸评估（OCTANE）是一项前瞻性研究，共纳入了超过 4500 名患有实体瘤的患者进行 NGS 面板检测。我们对肿瘤内科医生进行了回顾性调查，以评估 NGS 检测对治疗决策的影响。

方法

2016 年至 2021 年期间，在玛格丽特公主癌症中心识别患者和治疗肿瘤内科医生。仅对肿瘤进行测序，使用 555 或 161 个癌症基因的基因面板进行。肿瘤内科医生被要求查看检测结果并完成一份调查，表明 NGS 检测是否影响治疗决策。本研究的主要结果是根据突变结果改变治疗的比率。使用单变量分析和混合效应模型评估患者、检测和医生因素与治疗变化的关系。

结果

共发送了 582 份调查问卷，其中 394 份（67.7%）完成。我们发现 188 例（47.7%）患者的检测结果被肿瘤内科医生归类为可操作，62 例（15.7%）患者与治疗相匹配，其中 37 例（60%）参加了临床试验，13 例（21%）接受了批准的药物治疗，4 例（6%）接受了非标签治疗，8 例（13%）避免了无效治疗。患者、检测和医生特征与治疗变化无显著相关性。接受匹配治疗的患者与未接受治疗的患者之间的总生存期无差异（=0.55，中位生存期未达到）。