Comprehensive genomic profiling in AYA cancer patients.

Abstract

11144 Background: Cancer types in Adolescents and Young Adults (AYA) vary by age. Since many AYA cancers are classified as rare, patients continue to face limited therapeutic options. This study evaluates the utility of comprehensive genomic profiling (CGP) and genome-matched therapies for AYA cancer patients, considering age-specific variations using a nationwide database. Methods: We analyzed data from 2,325 AYA patients (aged 15–39) who underwent CGP between 2019 and 2023. The genomic landscape and treatment status were assessed. Patients were classified into two groups: those with cancer types that are more common in those under 30 years of age and those categorized as other. Parameters were compared between the two groups. Results: The median age was 33 years, with TP53 being the most frequently altered gene. Overall, 275 patients (12%) were administrated for treatment based on CGP. Cytotoxic agents were suggested when no actionable molecular targets were identified. However, there was no significant difference in overall survival (OS) between patients who received the recommended therapies and those who did not (40 vs. 33 months, p = 0.07). A generational comparison of cancer incidence identified 6 cancer types that were more prevalent in patients under 30 years of age: bone, peripheral nervous system, central nervous system, germ cells, adrenal gland, and soft tissue (collectively referred to as 6 specific cancer types). Among patients with the 6 specific cancer types (N = 824), TP53 and STK11 were the most frequently altered genes, whereas TP53 and KRAS predominated in patients with other cancers (N = 1501). Treatment administrations, including cytotoxic agents, based on CGP were made for 50 patients (6.1%) and 225 patients (15%), respectively ( p < 0.01). Among these, 28 patients (56%) with the 6 specific cancer types and 54 patients (24%) with other cancers did not receive genome-matched therapies ( p < 0.01). Regarding OS, patients with other cancers who received the recommended therapies had significantly longer OS than those who did not (41 vs. 30 months, p < 0.01). However, in patients with the 6 specific cancer types, there was no significant difference in OS between those who received the recommended therapies and those who did not (38 vs 44 months, p = 0.33). Conclusions: The prognostic benefit of CGP may be limited for rare cancers that are prevalent among the younger generation, as fewer opportunities for receiving genome-matched therapies.