1559P - Equity of access and clinical impact of genomic testing in patients with cancer in a UK early phase clinical trials unit

Background

Advancement of comprehensive genomic profiling (CGP) technology enables genomic medicine to emerge as a promising cancer treatment selection approach. As clinical implementation expands, concerns arise regarding equity of access and clinical utility. This study investigated the influence of ethnicity, socioeconomic status, and other factors on access to genomic testing at a trials unit in the UK. The clinical impact was also studied.

Methods

A retrospective review of patients referred for CGP between 2015 to 2024 was conducted. The impact of access by age, cancer types, ethnicity, and socioeconomic status defined by Index of Multiple Deprivation (IMD,1 - most deprived; 10 - least deprived) was assessed by comparing against population data from the UK Office for National Statistics. Clinical utility metrics including matching rates to targeted therapies, frequency of genomic aberrations, sequencing success rate, turnaround time were assessed based on medical records.

Results

Data from 406 patients was compared against the catchment area population. Patients from more deprived socioeconomic backgrounds were less likely to partake in CGP (p < 0.001). Black and mixed ethnic background were under-represented in the analysis population (p < 0.001). Clinical utility aligned with larger studies but only 31 (8.2%) patients were started on a matched targeted therapy. Table: 1559P

Summary of demographic characteristics

Conclusions

Matching rate to targeted therapy or clinical trials remained low. The most common barriers were the lack of actionable mutation, unavailability of trials, and poor performance status. We also identified disparities of access to molecular testing associated with socioeconomic status and ethnicity. Current patient recruitment primarily relies on elective referrals from treating clinicians which could be a factor contributing to the observed disparity. Future efforts should focus on establishing a centralised, automated referral pathway.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Guy's and St Thomas' NHS Foundation Trust.

Funding

Has not received any funding.

Disclosure

J. Spicer: Financial Interests, Institutional, Advisory Board, Compensation to my employer for time providing advice: AstraZeneca, BMS, GSK, RS Oncology; Financial Interests, Personal, Stocks/Shares, Co-founder: Epsilogen; Financial Interests, Personal, Stocks/Shares: Avacta; Financial Interests, Institutional, Local PI, Reimbursement for treatment of patients in trial: Achilles, Roche, Trizell, BergenBio, MSD, Gilead, Iovance; Financial Interests, Institutional, Coordinating PI, Reimbursement for treatment of patients in trial: Starpharma, BMS, IO Biotech, RS Oncology; Non-Financial Interests, Leadership Role, National strategy board: Experimental Cancer Medicine Centres; Non-Financial Interests, Member of Board of Directors, Steering Committee: British Thoracic Oncology Group; Non-Financial Interests, Advisory Role, Advice on licensing decisions for MHRA: CHM Expert Advisory Group on Oncology & Haematology; Non-Financial Interests, Advisory Role, Advice on regulatory approvals: CHM Cancer Vaccines Expert Working Group. D. Sarker: Financial Interests, Personal, Advisory Board: Eisai, Ipsen, Bayer, Surface Oncology, AAA, AbbVie, Boehringer Ingelheim, AstraZeneca, Incyte; Financial Interests, Personal, Invited Speaker: MSD, Bayer, AstraZeneca, Eisai, Servier, Incyte; Financial Interests, Personal, Other, Travel and conference fees: Ipsen; Financial Interests, Personal, Other, Travel and Conference Fees: MiNA Therapeutics; Financial Interests, Institutional, Coordinating PI: UCB, MiNA Therapeutics; Financial Interests, Institutional, Local PI: Eisai, Medivir AB, MSD, Bayer, RedX, GSK, Starpharma, Adaptimmune, Blueprint, H3, Regeneron, Taiho, AstraZeneca, Ipsen; Financial Interests, Institutional, Funding: Roche, Inspirata; Non-Financial Interests, Advisory Role: Medivir, UCB, MiNA Therapeutics. All other authors have declared no conflicts of interest.