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Med Oncol. 2019 Dec 21;37(2):12. doi: 10.1007/s12032-019-1336-3.

Prospective assessment of the clinical benefit of a tailored cancer gene set built on a next-generation sequencing platform in patients with recurrent or metastatic head and neck cancer.

Author information

1
Division of Medical Oncology, Washington University School of Medicine, 660 South Euclid, Campus Box 8056, St. Louis, MO, 63110, USA.
2
Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
3
Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.
4
Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
5
Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA.
6
Division of Medical Oncology, Washington University School of Medicine, 660 South Euclid, Campus Box 8056, St. Louis, MO, 63110, USA. dadkins@wustl.edu.
7
Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA. dadkins@wustl.edu.

Abstract

We performed a prospective trial to assess the clinical benefit of a tailored gene set built on a next-generation sequencing (NGS) platform in patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). Archived tumor tissue obtained from patients with recurrent or metastatic HNSCC was analyzed for variants by a tailored Comprehensive Cancer Gene set of 40 genes (CCG-40) performed on a NGS platform. These data were provided to clinicians to inform treatment decisions. The primary endpoint was clinical benefit (disease control) that resulted from selection and administration of a targeted therapy based on results of the CCG-40. Barriers to performance and implementation of the assay were recorded. Forty patients enrolled. Primary tumor sites included oropharynx (14), larynx/hypopharynx (14), oral cavity (9), and nasopharynx (3). The CCG-40 assay was performed in 23 patients (57.5%), but not in 17 patients due inadequate financial coverage (12) or insufficient tumor tissue (5). Potentially actionable tumor variants were identified in 3 patients (7.5%); all were PIK3CA variants. Due to inability to obtain access to candidate drugs (2) or rapid decline in performance status (1), none of these patients received targeted therapy informed by the CCG-40 results. The CCG-40 assay did not provide clinical benefit to the patients on this trial. Identification of limitations of the assay and barriers to the test's performance and application may be used to optimize this strategy in future trials.

KEYWORDS:

Head and neck cancer; Metastasis; Precision medicine

PMID:
31865465
DOI:
10.1007/s12032-019-1336-3

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