Use of targeted treatments for advanced cancer increasing in community setting

MUNICH — Nearly one-quarter of patients with metastatic cancer who underwent comprehensive genomic profiling at National Comprehensive Cancer Network centers in the United States received a genomically matched treatment, according to study results presented at European Society for Medical Oncology Congress.

The findings show precision medicine is moving beyond highly specialized centers, Ricardo H. Alvarez, MD, MSc, medical oncologist at Cancer Treatment Centers of America in Atlanta, and colleagues concluded.

“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,” Alvarez said in a press release.

Alvarez and colleagues analyzed data from 6,177 patients (median age, 56 years; range, 18-94; 61% women; 68% white) with advanced cancer who underwent comprehensive genomic profiling between January 2013 and September 2017 within NCCN, a community practice cancer network.

The most common tumor types included breast cancer (18%), colorectal cancer (15%), lung cancer (14%) and gynecologic cancer (11%).

Three genomic platforms developed by Foundation Medicine were used: FoundationOne (315 genes; 89% of tests), FoundationOne-Heme (405 genes; 6% of tests) and FoundationAct (62 genes; 5% of tests).

The majority (94%; n = 5,839 of 6,496) of comprehensive genomic profiling assays revealed genomic alterations, 47% of which were classified as clinically relevant.

The most frequent clinically relevant genomic alterations were in KRAS (23%) and PIK3CA (15%), and the most common alterations were amplification (32%).

Researchers analyzed treatment data for a considerable portion of the cohort (n = 4,490).

Results showed 23% (n = 1,169) were matched to targeted drugs. Of this subset, 57% (n = 662) received therapies the FDA had approved for a different tumor type, and 15% (n = 178) received treatment through clinical trials.

The percentage of patients who received matched treatment through clinical trials increased during the study period due to increased access through the Targeted Agent and Profiling Utilization Registry (TAPUR) study, a nonrandomized clinical trial led by ASCO that is designed to investigate the use of FDA-approved, molecularly targeted cancer therapies for patients with advanced cancers that have actionable genomic variants.

“In a large series of diverse patients assayed with comprehensive genomic profiling in the community setting, 23% of patients received matched treatment, which was predominantly targeted therapy,” Alvarez and colleagues wrote. “The increasing frequency of matching treatment over time, and the advent of immunotherapy and matching with PD-L1 and tumor mutational burden, may further increase the proportion of this population.”

Researchers intend to analyze outcomes of patients matched to targeted therapies.

The study offers key insights into the impact of genomic research on patient care and clinical decision-making in the community setting, according to Joaquin Mateo, MD, PhD, principal investigator of the Prostate Cancer Translational Research Group at Vall d’Hebron Institute of Oncology in Barcelona.

“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, who was not involved in the study, said in the release.

Mateo said he eagerly awaits additional information about how tumor profiling guided treatment decisions, as well as the costs associated with analyzing DNA samples from such a sizable patient population.

“The affordability of precision medicine is an important issue, and we will need to address the challenge of ensuring efficient use of funds if we can only apply the results of tumor DNA testing to the treatment of a quarter of patients,” Mateo said.

A lack of standard criteria for determining which targeted treatments should match specific tumor DNA alterations, as well as differences in availability of targeted treatments, may lead to variability with regard to which patients receive which agents, Mateo added.

“We need to be confident that matches, and the reporting of genomics data and their interpretation, are robust across all treatment centers, whether they are in hospital or the community,” Mateo said. “This will make targeted treatments based on these DNA alterations more likely to benefit our patients.” – by Mark Leiser

Reference: Alvarez RH, et al. Abstract 1891O_PR. Presented at: European Society for Medical Oncology Congress; Oct. 19-23, 2018; Munich.

Disclosure: Alvarez reports no relevant financial disclosures. Four study authors report employment with and stock ownership in Foundation Medicine.