Most Oncologists Report Using Sequencing-Based Panels In Practice

The majority of U.S. oncologists report using next-generation sequencing-based (NGS-based) tests to guide patient care, according to a study published Nov. 13 in JCO Precision Oncology, although use varied by clinicians’ practice characteristics.

There has been some concern that the rapid pace of development of new commercial tumor gene sequencing panels has overwhelmed clinicians making it difficult for them to effectively incorporate new tests into routine patient care, given the volume of available tests, the scant data on their clinical utility, and the limited incorporation of such tests into evidence-based clinical guidelines.

Researchers used data from the National Survey of Precision Medicine in Cancer Treatment (February through May of 2017). The mailed survey was sent to a nationally representative sample of oncologists, with 1,281 of 3,378 participating. The National Cancer Institute, the National Human Genomic Research Institute, and the American Cancer Society sponsor the survey.

Most responding oncologists were male (66.4 percent) and white (62.6 percent). Less than one-third of respondents (31.1 percent) were in the 40- to 49-year age range. Geographically, about 10 percent of respondents reported practicing in a rural setting. Most respondents reported an affiliation with an academic institution. More than one half of respondents (56.3 percent) reported having some training in genomic testing. On average, respondents see 101 unique cancer patients each month.

The researchers found that three-quarters of oncologists reported using NGS tests to guide treatment decisions. However, use differed according to the physician’s demographic and practice characteristics. Use of NGS tests was more common among younger oncologists (less than 50 years of age), as well as those holding a faculty appointment, having genomics training, seeing more than 50 unique patients per month, and having access to a molecular tumor board.

NGS test results informed treatment often for 26.8 percent of respondents, sometimes for 52.4 percent, and never or rarely for 20.8 percent of oncologists. Of the oncologists who reported using NGS tests often in the past 12 months, 34.0 percent did so to guide treatment decisions for patients with advanced refractory disease, 29.1 percent to determine eligibility for clinical trials, and 17.5 percent to inform off-label use of Food and Drug Administration–approved drugs.

“These results may reflect oncologists’ use of NGS testing to inform treatment strategies when established therapies have failed or when there is uncertainty about the usefulness of existing treatment guidelines for less common clinical situations,” write the authors led by Andrew Freedman, from the National Cancer Institute in Rockville, Md.

The survey asked specifically about 11 commercially available NGS tests, including: CancerSELECT or Cancer Complete, Caris Molecular Intelligence or Target Now, CGI Complete, FoundationOne, FoundationOneHeme, FoundationACT, GPS Cancer, Guardant360, Omniseq Comprehensive, OnkoSight Tumor Panels, and ARUP Laboratories’ Solid Tumor Mutation Panel. Multimarker gene-expression profiling (e.g., Oncotype DX for breast cancer) were not classified as NGS tumor tests. Among the 959 oncologists who ordered any of these NGS tests, past 12 month volumes were low, with 28.2 percent ordering one test, 31.7 percent ordering two tests, 23.3 percent ordering three tests, and 16.7 percent ordering four or more tests.

More than half of oncologists reported that NGS test results were difficult to interpret either often or sometimes. One-quarter said they referred patients to other providers for NGS testing, possibly suggesting a lack of expertise or comfort for ordering and interpreting NGS tests.

Takeaway: NGS-based tests are being used in clinical practice to inform treatment decisions for solid tumors. However, use varies by oncologists’ personal and practice characteristics and seems to inform care particularly for more difficult cases.