116P - Switching to a multigenic parallel sequencing approach: The landscape of biomarkers profiling changing between immunohistochemistry and next generation sequencing advantages and sustainability from a public hospital in Northern Italy

Background

Precision medicine, a tailored approach based on tumor profiling and actionable genetic mutations detection, is the new paradigm for oncologic patients management. An increasing number of genes is tested after new targeting drug approvals with high impacts in terms of costs and report turnaround time.

Methods

Using Diaceutics Data Repository, a global multi source database including commercial claims and laboratory data, we analyzed testing and positivity rate to compare the 2022 and 2023 diagnostic activity of the laboratory.

Results

2023 data analysis reveals NGS as the primary method used currently for the majority of tumors such as lung (90%), colorectal cancers (70%) and melanoma (78%) while in 2022 the sequential testing approach by real time PCR and FISH was the standard approach for all samples. Following the approval of new drugs in 2022, the laboratory also covers in 2023 new disease entities by NGS testing such as cholangiocarcinoma and endometrial cancer. Immunohistochemistry also encountered consistent changes: ALK5A4 antibody is now only used as a confirmatory tool for ALK gene rearrangements (previously detected by molecular testing); PAN-TRK antibody used for NTRK genes fusions screening increased and PD-L1 testing is also performed in colorectal, melanoma, head and neck squamous cancers in addition to lung adenocarcinoma.

Conclusions

Our laboratory successfully experienced a switch to NGS sequencing technology in a very short time. An automated system for library preparation was shown to be helpful for results standardization and sample tracking in a laboratory not so experienced in molecular approaches. We also demonstrated that little customized panels are suitable to detect actionable genetic alterations as recommended by International Guidelines. A parallel sequencing approach introduced in the routine of a middle size public pathology laboratory is possible and cost effective.

Editorial acknowledgement

We would like to thank Diaceutics PLC who provided data and analytic support on their DXRX platform for this research.

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.