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Accessing Targeted Therapies: A Potential Roadblock to Implementing Precision Oncology?
Mitchell S von Itzstein1,2, Mary L Smith3, Elda Railey3
1Division on Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
JCO Oncology Practice
|May 10, 2021
Summary
Next-generation sequencing (NGS) offers actionable insights in cancer care, but patient access to therapies remains a challenge. Clinicians also use NGS guidance for unapproved treatments or clinical trials.
Area of Science:
- Genomic Medicine
- Oncology
- Clinical Decision-Making
Background:
- Next-generation sequencing (NGS) is increasingly utilized due to advances in genomic techniques.
- Evaluating the impact of NGS on clinical treatment decisions is crucial.
Purpose of the Study:
- To assess the extent to which next-generation sequencing (NGS) guides cancer treatment decisions.
- To identify challenges in accessing therapies based on NGS results.
Main Methods:
- A survey was distributed to American Society of Clinical Oncology (ASCO) members to assess NGS use and outcomes.
- Statistical analyses included Wilcoxon two-sample, chi-square, and Fisher's exact tests.
Main Results:
- Over half of respondents found NGS provided actionable information. NGS use varied by cancer type, highest in lung and gastric cancers.
- A third of clinicians faced challenges accessing FDA-approved therapies for actionable molecular variants.
- NGS results influenced decisions to pursue compassionate use, clinical trials, or off-label treatments.
Conclusions:
- Clinicians encounter significant barriers in accessing approved therapies for actionable NGS findings.
- The perceived impact of NGS influences clinical behaviors, including the pursuit of unapproved or off-label treatments and clinical trial enrollment.
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