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Institutional Review Data Indicate That Actionable Genetic Testing and Personalized Medicine in Hepatobiliary and Pancreatic Cancers Is Rarely Applied

2020 Year in Review: Cholangiocarcinoma — December 19, 2020

Real-world data indicate that genetic testing and personalized medicine is rarely applied in the community setting for patients with hepatobiliary and pancreatic cancers.

Given the importance of early identification of actionable genetic alterations for practice of precision medicine in patients with hepatobiliary and pancreatic cancers, a retrospective analysis was conducted to analyze the incidence of actionable genetic alterations in a large community health system, the results of which were reported at the American Society of Clinical Oncology (ASCO) 2020 Gastrointestinal Cancers Symposium.

An institutional review was performed to identify patients with hepatocellular carcinoma (HCC), intrahepatic CCA, extrahepatic CCA, gallbladder carcinoma, or pancreatic adenocarcinoma who underwent molecular panel testing in the Oncology Precision Medicine database at Advocate Aurora Health, Milwaukee, WI. Patients were stratified by cancer type, and treatment course was analyzed using swimmer plots.

A total of 456 patients diagnosed with HCC, intrahepatic CCA, extrahepatic CCA, gallbladder carcinoma, or pancreatic adenocarcinoma were identified in the Oncology Precision Medicine database. Of these, 88 (19.3%) patients completed molecular testing and were included in the analysis. Of the 88 patients, 18 (20.4%) patients had intrahepatic or extrahepatic CCA, 2 (2.3%) patients had HCC, 5 (5.7%) patients had gallbladder carcinoma, and 63 (71.6%) patients had pancreatic adenocarcinoma. In total, actionable mutations were identified in 8 (9.1%) patients. Of these, 5 patients had BRAF mutations (pancreatic adenocarcinoma, N = 2; intrahepatic or extrahepatic CCA, N = 2; gallbladder carcinoma, N = 1); 2 patients subsequently began targeted therapy, 1 had a PFS of 2.5 months and the other discontinued secondary to toxicity. Three patients harbored BRCA1/2 mutations, all in patients with pancreatic adenocarcinoma (3 of 63 [4.8%]); however, they did not receive BRCA-targeted therapies.

These data indicate that only a minority of patients with hepatobiliary and pancreatic cancers undergo genetic testing in a real-world clinical practice setting, underscoring the need for early and systematic genetic testing to identify actionable genetic alterations that may allow early initiation of appropriate targeted therapy to improve patient outcomes.

Source: Bellini G, et al. J Clin Oncol. 2020;38(4_suppl). Abstract 570.

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