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Oncotarget. 2018 Apr 17;9(29):20282-20293. doi: 10.18632/oncotarget.24757. eCollection 2018 Apr 17.

The clinical impact of using complex molecular profiling strategies in routine oncology practice.

Author information

1
Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
2
Institut Hospital del Mar d'Investigacions Médiques, Barcelona, Spain.
3
Harvard University, Cambridge, Massachusetts, USA.
4
Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
5
Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
6
Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
7
Fundación Jimenez Díaz, IDC Salud, Madrid, Spain.
8
Docrates Cancer Center, Helsinki, Finland.
9
Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
10
Cancercare, Cape Town, South Africa.
11
University Hospital Birmingham NHS Trust, University of Birmingham, Edgbaston, UK.
12
The London Breast Clinic, London, UK.
13
Kent Oncology Centre, Kent, UK.
14
The Princess Grace Hospital, London, UK.
15
Clinique Rambot-Provençale, Aix-en-Provence, France.
16
Vinnitsa Regional Clinical Oncology Center, Vinnitsa, Ukraine.
17
St. James University Hospital, Leeds, UK.
18
Clinica Las Condes, Santiago, Chile.
19
King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
20
Specialized Medical Center Hospital, Riyadh, Saudi Arabia.
21
Kasr El-Aini Hospital, Cairo University, Cairo, Egypt.
22
Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon.
23
Saint Joseph University, Hôtel-Dieu de France University Hospital, Beirut, Lebanon.
24
Nuffield Hospital, Chester, UK.

Abstract

Molecular profiling and functional assessment of signalling pathways of advanced solid tumours are becoming increasingly available. However, their clinical utility in guiding patients' treatment remains unknown. Here, we assessed whether molecular profiling helps physicians in therapeutic decision making by analysing the molecular profiles of 1057 advanced cancer patient samples after failing at least one standard of care treatment using a combination of next-generation sequencing (NGS), immunohistochemistry (IHC) and other specific tests. The resulting information was interpreted and personalized treatments for each patient were suggested. Our data showed that NGS alone provided the oncologist with useful information in 10-50% of cases (depending on cancer type), whereas the addition of IHC/other tests increased extensively the usefulness of the information provided. Using internet surveys, we investigated how therapy recommendations influenced treatment choice of the oncologist. For patients who were still alive after the provision of the molecular information (76.8%), 60.4% of their oncologists followed report recommendations. Most treatment decisions (93.4%) were made based on the combination of NGS and IHC/other tests, and an approved drug- rather than clinical trial enrolment- was the main treatment choice. Most common reasons given by physicians to explain the non-adherence to recommendations were drug availability and cost, which remain barriers to personalised precision medicine. Finally, we observed that 27% of patients treated with the suggested therapies had an overall survival > 12 months. Our study demonstrates that the combination of NGS and IHC/other tests provides the most useful information in aiding treatment decisions by oncologists in routine clinical practice.

KEYWORDS:

molecular profiling; next-generation sequencing; precision medicine; solid tumour; therapeutic decision making in oncology

Conflict of interest statement

CONFLICTS OF INTEREST HS, AF, GG and J-FL are employees of OncoDNA. GG and J-FL report ownership of OncoDNA shares etc.

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