Clinical outcome of comprehensive genomic profiling (CGP) driven personalized treatment in cancer patients based on the decision of Apex Molecular Tumor Board (MTB): An Indian multi-centric real-world data.

Abstract

e23013 Background: CGP followed by MDT-based therapy recommendation plays a synergistic role in improving clinical outcomes of cancer patients. CGP in clinical practice detects broad-spectrum therapeutic, prognostic, and predictive biomarkers. MTB plays a crucial role in the assessment of molecular test results and integrating them into clinical practice. Methods: In a multicentric, IRB-approved study, 1000 biopsy-proven cancer patients were profiled by Next Generation Sequencing (NGS) using TruSight Oncology 500 gene panel . MTB recommendations were collated and followed up with an emphasis on therapeutic interventions and patient outcome. The treatment planning data before and after genetic testing were obtained from the Electronic Medical Report (EMR) to evaluate the clinical outcome. Results: Clinical outcome data were available via EMR for 618/1000 patients (62%). Actionable genetic alterations (Tier I + Tier II) were found in 458 patients (74%; 96% CI 70.6%-77.4%). Among 458 patients with ≥1 actionable genomic alteration, 200 patients (44%; 95% CI 39.1%-48.1%) were enrolled for MTB discussion. Based on inputs from MTB, treatment modifications were made in 137 patients (69%; 95% CI 62.4%-74.6%). The number of patients assigned to tumor-agnostic therapy post-MDT (n = 137) is shown in Table 1. CGP matched therapy was also recommended in 61/258 (24%) patients, not enrolled in MTB. Overall, 69% (n = 137/200) of cases discussed in MTB received a change in therapy compared to 24% (n = 61/258) of cases not discussed in MTB, thus establishing the importance of MTB in personalized genomics-driven treatment. Interim analysis of MTB-discussed cases showed 71% (n = 97/137) of cases to be alive with a median follow up of 18 months (12-24 months) with favorable clinical outcome. Conclusions: The current study revealed that the CGP results discussed in the MTB prompted a change in therapeutic decisions in > 60% of patients and established a foundation for introducing CGP and MTB in clinical practice to improve clinical outcomes and reduce healthcare costs in emerging economic countries. Clinical outcome of patients on CGP matched targeted therapy. Targeted Therapy No. of patients Indication Clinical OutcomeCR: Complete Response; PR: Partial Response; PD: Progressive Disease ICI 44 TMB>10mut/ mb and/or MSI-20% unstable sites. CR (n=5); PR (n=21); PD (n=1) Platinum/PARP 22 BRCA and/or HRR CR (n=12); PR (n=5); PD (n=1) EGFR TKIs 21 EGFR TKD mutation CR (n=12); PR (n=2); PD (n=1) Other TKIS 15 ROS1/RET/NTRK/MET/BRAF CR (n=11); PR (n=6) HER2 mAB 17 HER2 amplification CR (n=17); PR (n=4) mTOR inhibitors 5 PIK3CA/AKT/mTOR CR (n=0); PR (n=2); PD (n=1) ALK inhibitor 4 ALK Fusion CR (n=3); PR (n=1) Sotorasib 3 KRAS G12C CR (n=2); PR (n=1) FGF/FGFR inhibitor(1) 1 FGF/ FGFR PR (n=1) Others 5