Comprehensive tumor profiling-guided therapy in rare or refractory solid cancer: A feasibility study in daily clinical practice

Autor: Marwan Ghosn, Elie El Rassy, Joseph Kattan, Fadi Farhat, Tony Ibrahim, Colette Hanna, Abir Ahmadie, Fadi El Karak
Rok vydání: 2019
Předmět:
0301 basic medicine
Oncology
Male
Cancer Research
Kaplan-Meier Estimate
Tumor response
0302 clinical medicine
Neoplasms
Antineoplastic Combined Chemotherapy Protocols
Medicine
Molecular Targeted Therapy
In Situ Hybridization
Aged
80 and over
High-Throughput Nucleotide Sequencing
Hematology
General Medicine
Middle Aged
Immunohistochemistry
Progression-Free Survival
Neoplasm Proteins
Clinical Practice
Survival Rate
030220 oncology & carcinogenesis
Female
Algorithms
Adult
medicine.medical_specialty
Solid cancer
Clinical Decision-Making
Protein Array Analysis
Antineoplastic Agents
03 medical and health sciences
Young Adult
Rare Diseases
Internal medicine
Biomarkers
Tumor
Humans
Radiology
Nuclear Medicine and imaging
In patient
Objective response
Response Evaluation Criteria in Solid Tumors
Aged
Probability
business.industry
Clinical trial
Log-rank test
030104 developmental biology
Mutation
Feasibility Studies
Personalized medicine
business
Zdroj: Bulletin du cancer. 107(4)
ISSN: 1769-6917
Popis: Tumor profiling has been shown to benefit patients with rare or refractory metastatic cancer, but several limitations hamper its use in daily clinical practice. We aim to assess the added benefit of a comprehensive tumor profiling, including factors predictive of response to targeted and cytotoxic therapy, in the treatment of refractory or rare solid tumors outside of a formal clinical trial. Patients were included between 2013 and 2017. Multiplatform comprehensive tumor profiling (CTP) was performed on FFPE specimens. Tumor response was evaluated by imaging using the RECIST criteria version 1.1. The PFS ratio was defined as PFS under CTP-guided therapy (PFS2)/PFS under previous standard therapy (PFS1). A clinical benefit was identified if the PFS ratio exceeded the 1.3 threshold value. In total, 184 patients were enrolled among whom 104 were evaluable for the PFS ratio. Objective response rates (ORR) were equal to 25% (CI95: 16.6-33.4%) and 36.5% (CI95: 27.2-45.8%) on the last therapy before CTP and on the CTP-guided therapy respectively (P-value=0.058 on paired proportion comparison test). The proportion of patients achieving a PFS2/PFS1 ratio≥1.3 was equal to 50%. The median PFS1 was statistically lower than PFS2 (120 days compared to 184 days respectively, P-value log rank 0.01). These results confirm the feasibility and the added benefit of a CTP in patients with refractory tumors in daily clinical practice especially in patients not able to enter a clinical trial.
Databáze: OpenAIRE
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