Integrating 40-GEP Testing to Improve Clinical Recommendations for Adjuvant Radiation for Cutaneous Squamous Cell...

Area of Science:

• Oncology
• Dermatology
• Genomics

Background:

• Early identification of high-risk cutaneous squamous cell carcinoma (cSCC) is crucial for preventing metastasis.
• Current prognostic tools like AJCC-8 and NCCN guidelines rely on clinicopathologic factors, limiting prognostic accuracy.
• Gene expression profiling (GEP) offers an objective metric to enhance risk stratification in cSCC.

Purpose of the Study:

• To evaluate the utility of 40-GEP testing in clinical decision-making for adjuvant radiation therapy (ART) in cSCC patients.
• To integrate 40-GEP testing into existing management guidelines (NCCN) and staging systems (AJCC-8).
• To develop a risk-based clinical workflow for ART decisions using 40-GEP results.

Main Methods:

• A multidisciplinary panel of radiation oncologists and dermatologists/Mohs surgeons convened to discuss 40-GEP utility.
• Review of the validated 40-GEP test's ability to classify patients into low (Class 1), higher (Class 2A), or highest (Class 2B) risk categories for metastasis.
• Development of a clinical workflow incorporating 40-GEP into ART decision-making.

Main Results:

• The 40-GEP test accurately classifies cSCC patients' biological risk of metastasis within three years.
• Panel identified key clinical utility for 40-GEP in escalating care for lower-stage high-risk tumors.
• 40-GEP aids in de-escalating care when ART risks outweigh benefits and in decisions on elective nodal radiation.

Conclusions:

• 40-GEP testing provides objective, actionable risk stratification for cSCC patients.
• Integrating 40-GEP into NCCN guidelines and AJCC-8 staging optimizes ART decisions.
• A risk-based workflow utilizing 40-GEP enhances personalized management for cSCC, improving outcomes.