Abstract：
OBJECTIVE: 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 (P = .55, median survival not reached).
CONCLUSIONS: 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.
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 (P = .55, median survival not reached).
CONCLUSIONS: 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）小组测试的临床应用信息有限，无法为晚期实体瘤患者的决策提供信息。安大略省范围的癌症靶向核酸评估（OCTANE）是一项前瞻性研究，招募了4,500多名实体瘤患者进行NGS小组测试。我们对医学肿瘤学家进行了回顾性调查，以评估NGS测试对治疗决策的影响。
方法：2016年至2021年在玛格丽特公主癌症中心确定了患者和肿瘤学家。使用555或161个癌症基因的基因组进行仅肿瘤测序。要求肿瘤学家审查测试结果并完成一项调查，表明NGS测试是否影响治疗决策。这项研究的主要结果是基于突变结果的治疗变化率。病人,test,使用单变量分析和混合效应模型评估了医师因素与治疗变化的相关性.
结果：在发送的582份调查中，完成394（67.7%）。我们发现，188（47.7％）患者的测试结果被肿瘤学家归类为可操作的，62（15.7％）患者与治疗相匹配。其中37人（60%）参加了临床试验，13人（21%）接受了批准的药物，4例（6%）是处方外治疗，和8（13％）避免无效的治疗。病人,test,和医师特征与治疗变化无显著相关。接受匹配治疗的患者与未接受匹配治疗的患者之间的总生存期没有差异（P=0.55，中位生存期未达到）。
结论：OCTANE检测导致15.7%患者的药物治疗发生变化，支持NGS小组检测对晚期实体瘤患者的临床应用。
方法：2016年至2021年在玛格丽特公主癌症中心确定了患者和肿瘤学家。使用555或161个癌症基因的基因组进行仅肿瘤测序。要求肿瘤学家审查测试结果并完成一项调查，表明NGS测试是否影响治疗决策。这项研究的主要结果是基于突变结果的治疗变化率。病人,test,使用单变量分析和混合效应模型评估了医师因素与治疗变化的相关性.
结果：在发送的582份调查中，完成394（67.7%）。我们发现，188（47.7％）患者的测试结果被肿瘤学家归类为可操作的，62（15.7％）患者与治疗相匹配。其中37人（60%）参加了临床试验，13人（21%）接受了批准的药物，4例（6%）是处方外治疗，和8（13％）避免无效的治疗。病人,test,和医师特征与治疗变化无显著相关。接受匹配治疗的患者与未接受匹配治疗的患者之间的总生存期没有差异（P=0.55，中位生存期未达到）。
结论：OCTANE检测导致15.7%患者的药物治疗发生变化，支持NGS小组检测对晚期实体瘤患者的临床应用。
