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

Jean François Laes*, Philippe Aftimos, Philippe Barthelemy, Joaquim Bellmunt, Guy Berchem, Carlos Camps, Ramón de las Peñas, Ana Finzel, Jesús García-Foncillas, Petteri Hervonen, Ibrahim Wahid, Timo Joensuu, Louis Kathan, Anthony Kong, James Mackay, Christos Mikropoulos, Kefah Mokbel, Jean Loup Mouysset, Sergey Odarchenko, Timothy J. PerrenRika Pienaar, Carlos Regonesi, Shadi Salem Alkhayyat, Abdul Rahman El Kinge, Omalkhair Abulkhair, Khaled Morsi Galal, Hady Ghanem, Fadi El Karak, Angel Garcia, Gregori Ghitti, Helen Sadik

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

15 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)20282-20293
Number of pages12
JournalOncotarget
Volume9
Issue number29
DOIs
Publication statusPublished - 17 Apr 2018
Externally publishedYes

Keywords

  • Molecular profiling
  • Next-generation sequencing
  • Precision medicine
  • Solid tumour
  • Therapeutic decision making in oncology

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