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ESMO 2018: Precision Cancer Care Moves to Community Setting

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Key Points

  • DNA alterations were identified in 94% (5,839 of 6,496) of tumor samples, of which 47% were considered clinically relevant.
  • Analysis of a large subset of patients showed that 23% (1,169 of 4,490) received treatment matched to DNA alterations in their tumors.
  • Of patients whose DNA alterations were matched to targeted drugs, 57% (662 of 1,169) received therapies already approved by the U.S. Food and Drug Administration for a different type of tumor, and 15% (178 of 1,169) received treatments in clinical trials.

Nearly 1 in 4 patients with advanced cancer treated at a community practice cancer network in the United States received innovative drugs matched to DNA mutations in their tumors. These results, to be reported by Alvarez et al at the European Society for Medical Oncology (ESMO) 2018 Congress (Abstract 1891O_PR), show that precision medicine is spreading from highly specialized cancer care centers to other health-care facilities.

“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,” said Ricardo H. Alvarez, MD, MSc, medical oncologist at Cancer Treatment Centers of America, Atlanta. “At our hospitals, we can identify patients with advanced cancer refractory to previous treatment, and take tissue or liquid biopsies which we send to a central laboratory for analysis and get results within 3 weeks. If these show alterations in tumor DNA which can be matched to a targeted medicine, we initiate treatment usually with a drug that has been approved for use against a different tumor type, or through enrollment in a gene-directed clinical trial,” Dr. Alvarez explained.

Increase in Analysis, Matching

In the new study, tumor DNA data was analyzed from 6,177 patients with advanced cancer treated by over 50 oncologists at five hospitals of Cancer Treatment Centers of America from 2013–2017. DNA alterations were identified in 94% (5,839 of 6,496) of tumor samples, of which 47% were considered clinically relevant.

Analysis of a large subset of patients showed that 23% (1,169 of 4,490) received treatment matched to DNA alterations in their tumors. This compares with 11% of patients being enrolled in clinical trials of targeted treatment on the basis of tumor DNA alterations in previously reported studies at academic centers (Meric-Bernstam et al in the Journal of Clinical Oncology, Zehir et al in Nature Medicine).

The tumors most commonly treated by the community oncologists were breast (18%), colorectal (15%), lung (14%), and gynecologic (11%). The most frequent clinically relevant tumor DNA changes were in the KRAS (23%) and PIK3CA (15%) genes, with the most common alterations being gene amplification (32%). Of patients whose DNA alterations were matched to targeted drugs, 57% (662 of 1,169) received therapies already approved by the U.S. Food and Drug Administration for a different type of tumor, and 15% (178 of 1,169) received treatments in clinical trials.

“In the next few years, we hope that as many as 50% of our patients will receive matched treatment through clinical trials or off-label treatment with approved medicines,” said Dr. Alvarez. “It is so encouraging to see how precision medicine is changing the way we treat our patients in the community, and our next step is to analyze the effects of targeted treatment on survival and quality of life,” he added.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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