Labs Can Provide Novel Support for Physicians Ordering Multigene Panels

As the price of sequencing continues to drop and genomic testing in oncology continues to shift towards larger panels, physicians have self-reported difficulty in understanding results. Yet, the success of personalized medicine is dependent upon physicians’ ability to understand and act upon genomic results.

Two studies presented in poster sessions at the American Society of Clinical Oncology annual meeting (Chicago; June 1-5) highlight how laboratories can play an important and expanded role in making tumor panel results more understandable—either through consultation or changing the format of the reports themselves.

Remote Genomic Consultation
Remote genomic consultation can be effective in supporting community- based oncologists’ use of multigene genomic tumor panels, found researchers from Fox Chase Cancer Center in Philadelphia.

“Early multigene genomic tumor panel uptake has been slow among community oncologists due to their lower confidence to order, interpret, and act upon results,” writes lead author Michael J. Hall. To address this the researchers evaluated the effectiveness of telephone-based genomic consultation between community oncologists (in four practices) and an academic clinician linked to an institutional genomic tumor board.

The nine community oncologists completed baseline and follow-up assessments. Tumor blocks were evaluated at Fox Chase Cancer Center using a 50- gene tumor panel. Panel results were presented, when warranted, to the genomic tumor board. A tailored summary was provided to community oncologists.

The researchers found that 12 percent of samples were inadequate. Of the remaining samples tested, the researchers found that all yielded at more than one variant (range one to six). The majority of patients (59 percent) had a clinically relevant variant. Six variants were potentially actionable with approved therapy, while three other variants were associated with therapies in Phase I/II trials.

At baseline, the nine community-based oncologists had limited experience with tumor panels, with three-quarters of them having ordered less than five panels. Community oncologists’ self-reported barriers for panel testing included poor understanding of multigene tumor panels (67 percent), cost (89 percent), uncertain benefit (44 percent), and poor access to targeted therapies (67 percent). At follow up, half of community oncologists found genomic consultation “very useful.” Nearly two-thirds that multigene tumor panels paired with genomic consultation would “probably/definitely” increase their use of the panels.

Interactive Genomic Reports
Interactive, genomic reports may improve physicians’ ability to accurately assess genomic data, according to a study presented by researchers from the City of Hope in Duarte, Calif.

The researchers created web-based, interactive reports with enhanced data visualization elements and embedded decision support for panels with more than 300 genes. The study involved vignette-based surveys to determine whether exposure to the interactive reports, as compared to static reports, improves physicians’ genomic understanding and report-based satisfaction. More than 100 physicians at a major cancer center participated.

The researchers found that prior to viewing the case-based vignette reports, just over one-third of physicians reported that they found it difficult to make treatment recommendations based on the standard report in their routine practice. After viewing the case-based vignettes, physicians’ overall comprehension scores did not increase significantly. However, physicians who viewed the interactive report were significantly more likely to correctly assess sequencing quality and understand when reports needed to be interpreted with caution (e.g., low tumor purity). Satisfaction scores were significantly higher in the interactive group, compared to the static group.

The majority of physicians (88 percent) physicians confirmed the need for additional genomic support for providers. Of these physicians, two-thirds reported that interactive genomic reports would provide helpful support.

Takeaway: There are many novel ways (including remote consultation and enhanced reports) that laboratories can support physicians increase their understanding of results from multigene tumor panels.