Development and implementation of molecular oncology test e-consult at the VA North Texas Health Care System (VANTHCS).

Abstract

3068 Background: The VA National Precision Oncology Program (NPOP), launched in 2016 as part of the White House’s Cancer Moonshot Initiative, aimed to revolutionize cancer care through precision medicine for Veterans. Oncologists at the VANTXHCS utilized molecular testing to identify potentially actionable mutations to tailor treatment strategies more accurately. This study aims to evaluate the impact of the identification and impact of potentially actionable mutations with treatment decisions and overall survival. Methods: We conducted a retrospective chart review of Veterans with molecular oncology testing (MOT) at VANTXHCS from August 2019 to May 2024 to assess cancer type, prevalence of potentially actionable mutations, treatment decisions, targeted therapy utilization, and overall survival (OS). Potential actionable mutations were determined based on AMP/ASCO/CAP Variant Categorization mapped to the OncoKB FDA-Recognized Human Genetic Variant Database at the time of review. Results: 570 Veterans, almost exclusively male (N = 523, 92%) with solid tumors had MOT during the study period. Lung (N = 211, 37%), GI (N = 105, 21%), prostate (N = 49, 9%), pancreatobiliary (N = 46, 8%), head and neck cancers (N = 35, 6%) and GU (N = 30, 5%) were most common with a median overall survival (OS) of 15.93 months. Potential actionable mutations were present in 107 (18.7%) tumors, however only 41 (38%) of the mutations were associated with an FDA approved targeted therapy at the time of testing. Six Veterans (5.6%) received targeted therapy. Reasons for not receiving targeted therapy included secondary mutations ( i.e ., KRAS), ECOG performance status, hospice or community care and death. Veterans with potentially actionable mutations had significantly worse. Conclusions: In the VANTXHCS Veteran population males with lung cancer represents the main tumor type with molecular oncology testing. We observe actionable mutations in nearly 20% of patients tested, with only a minor subset receiving targeted therapy. Our data showed that patients with a potentially actionable mutation have worse overall survival than those that do not. However, treatment with a targeted therapy can significantly improve survival. In conclusion, these findings underscore the need for further research to identify barriers to increase appropriate use of targeted therapies in a timely fashion to improve patient outcomes and advance precision oncology practices.