Piotr Wysocki: Only biliary tract and ovarian advanced cancer patients seem to benefit from next-generation sequencing
Piotr Wysocki, Professor of Medicine and Head of the Department of Oncology at Jagiellonian University Hospital, shared on LinkedIn:
“Even though next-generation sequencing (NGS) is increasingly used in daily oncology practice to identify clinically actionable genomic alterations to facilitate decision-making, its impact on patient outcomes is largely unknown. Hernando-Calvo A et al. (eClinicalMedicine) have conducted a retrospective, longitudinal, propensity score-matched cohort study matching patients (all NGS-tested) enrolled in the OCTANE trial with patients who have not undergone NGS testing. The Ontario-wide Cancer Targeted Nucleic Acid Evaluation (OCTANE) was a prospective study in the province of Ontario to advance NGS panel testing and data sharing and to create a province-wide repository of biospecimens for future research.
The authors compared 782 OCTANE patients with 782 matched controls. The overall survival of patients enrolled in the OCTANE trial was not significantly better compared genomically untested cohort (HR=0.9; 95%CI 0.80–1.03).
The lack of OS benefit in patients from the OCTANE trial was observed despite the fact, that enrollment in OCTANE was associated with:
- Greater palliative systemic therapy (84.4% vs. 71.0%).
- More lines of therapy (2.1 vs. 1.8).
- More frequent clinical trial enrollment (first-line: 15.1% vs. 5.9%; any-line: 25.4% vs. 9.5%).
Enrollment in OCTANE trial was associated with:
- Significantly less death in acute inpatient care facilities (10.2% vs. 16.4%).
- Less aggressive care (27.4% vs. 33.1%).
- Less inpatient hospital admission within 30 days of death (8.2% vs. 10.1%).
- Less systemic therapy at the end of life (4.1% vs. 6.6%).
There were only two cancer patient groups that demonstrated significantly improved overall survival after undergoing NGS testing in the OCTANE trial:
- Ovarian cancer (HR: 0.64; 95%CI 0.50–0.83, adjusted p=0.049.
- Biliary tract cancers (HR: 0.65; 95% 0.40–1.06, adjusted p=0.049).
The study provides two critical information that should be considered, especially in low- and middle-income countries where access to NGS and NGS-driven targeted treatment is significantly restricted.
- NGS testing does not improve outcomes in unselected populations of advanced cancer patients.
NGS testing should be routinely considered in ovarian and biliary tract cancers.”
Read further.
Source: Piotr Wysocki/LinkedIn
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