98P - Clinical implementation of NGS and ESCAT for optimized cancer therapy

Background

Advances in next-generation sequencing (NGS) make possible the selection of highly targeted therapies based on a tumour's genetic profile, resulting in better outcomes with a potential impact on progression-free survival and overall survival (Bewicke-Copley F, 2019; Gibbs SN, 2023; Coquerelle S, 2020). Moreover, it seems to be a cost-effective test (Pruneri G, 2021). ESMO Scale of Actionability of molecular Targets (ESCAT) aids in evaluating treatment efficacy, emphasizing the promise of personalized medicine in cancer care (Mateo J, 2018; Mosele F, 2020; Mosele F, 2024). Therefore, we decided to review the experience of the test in our center together with the ESCAT.

Methods

A retrospective observational study was carried out with cancer patients who had undergone a NGS test from January 2017 to December 2023 in the Medical Oncology Service of our hospital. The study has been approved by the Ethics Committee.

Results

96 patients with a mean age of 54 years were included, 56% of whom were women. The most frequent tumours were cholangiocarcinoma (24%), colorectal cancer (16%), lung cancer (12%) and cancer of unknown primary (6%). 56% of the samples come from tissue and 100% of them were valid for examination. In 23% of cases the test was requested in the first-line setting. The mean number of tumor mutational burden and genomic alterations found was 5 respectively. The MAPK and cell-replication were the most frequently altered signalling pathways and 3% had microsatellite instability. An average of 16 clinical trials were available for these patients. 22% had actionable mutations with targeted therapy and tumor-specific evidence and 24% exhibited mutations but with evidence-based treatments for other tumour types. 34% of patients received treatment based on NGS results after the test, while 8% received it but in later treatment lines. 49% had a favourable ESCAT classification (I-II).

Conclusions

In our clinical experience the NGS test should be implemented in routine clinical practice for decision making. In order to benefit from the test, patients should be selected according to ESMO guidelines. ESCAT is a useful instrument to exploit. Prospective studies should be performed with a more homogeneous population to assess the impact of the NGS test and the ESCAT.

Editorial acknowledgement

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.