Most Oncologists Report They Actually Do Use Sequencing-Based Panels in Practice

Contrary to what some have suggested, a new study shows that most U.S. oncologists actually do use next-generation sequencing-based (NGS-based) tests to guide patient care with use varying by practice characteristics.

Are NGS Tests Being Used?

There has been some concern that the rapid pace of development and large volume of new commercial tumor gene sequencing panels has overwhelmed clinicians and made it difficult for them to incorporate new tests into routine patient care. Other doubts over use are fueled by the scant data demonstrating the clinical utility of such tests and their limited incorporation into evidence-based clinical guidelines.

The Study

Against this backdrop comes a new study published Nov. 13 in JCO Precision Oncology. Researchers used data from the National Survey of Precision Medicine in Cancer Treatment (February through May of 2017). The mailed survey, sponsored by the National Cancer Institute, the National Human Genomic Research Institute, and the American Cancer Society, was sent to a nationally representative sample of 3,378 oncologists, 1,281 of which responded.

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. About 10 percent reported practicing in a rural setting. Most respondents reported an affiliation with an academic institution. More than half of respondents (56.3 percent) reported having some training in genomic testing. On average, respondents reported seeing 101 unique cancer patients per month.

The Findings

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 was more common among oncologists who:

• Are under age 50;
• Hold a faculty appointment;
• Have genomics training;
• See more than 50 unique patients per month; and
• Have 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 FDA– 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.

Which NGS Tests Are Being Used

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, 23.3 percent ordering three, and 16.7 percent ordering four or more tests.

More than half 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: Despite doubts, NGS-based tests are apparently being used in clinical practice to inform treatment decisions for solid tumors.

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This article originally appeared in G2 Intelligence, Diagnostic Testing & Emerging Technologies, Jan. 2019

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