Real World Utility of Next-Generation Sequencing in Neuro-oncology Patients

Abstract

Purpose. There has been a proliferation of commercially available tumor molecular profiling services. However, there is a paucity of evidence as to whether these data result in treatment alterations or enrollment into clinical trials for neuro-oncology patients. This study analyses if increasing use of tumor profiling services has resulted in increased personal neuro-oncologic care with personalized targeted therapies.

Methods. We performed a retrospective chart review for all neuro-oncology patients at Geisinger Medical Center from 2016 to 2021 who underwent tumor profiling using commercial send-out testing. We analyzed factors including tumor pathology, actionable genes, treatment pre-tumor profiling, post- profiling, and survival after testing. The clinical action rate was based off these findings.

Results. From 2016 to 2021, 83 patients had tumor genetic and molecular profiling. Pathologies included glioblastoma (44.5%), metastases (10.8%), meningioma (9.63%), and others. There was increased testing from 2016 (n=1) to 2021 (n=28). In total, three patients (3.61%) had therapy offered based off NGS testing; these were adjudicated during analysis and did not result from the testing’s recommendations but were extrapolations from specific mutations. None of the patients were enrolled in clinical trials based off their test results. The overall mean charges of testing in the five patients for whom our health plan had data were $44,581.88 (range $42,218.97-$47,126.89).

Conclusion. Despite increased utilization of tumor profiling technologies in our patient cohort, we observed limited value in altering therapy. Selective testing for actionable alterations based on evidence and improved patient selection will be key to improve value of testing and make it more cost effective.