Key takeaways:
- Subsequent-generation sequencing testing charges have elevated for sufferers with metastatic prostate or urothelial most cancers since 2015.
- Race, medical insurance standing and different elements correlated with probability of testing.
Charges of next-generation sequencing have elevated for people with metastatic prostate most cancers or superior urothelial carcinoma over the previous a number of years, however greater than half of those people nonetheless don’t endure testing.
A number of elements — together with race, insurance coverage standing and socioeconomic standing — considerably correlated with probability of testing, retrospective examine outcomes confirmed.
Greater than half of sufferers with metastatic prostate or urothelial cancers didn’t endure next-generation sequencing. Picture: Adobe Inventory
“Regardless of the presence of actionable mutations in prostate and urothelial cancers, the vast majority of sufferers in each cohorts don’t endure testing,” Chadi Hage Chehade, MD, post-doctoral analysis fellow at Huntsman Most cancers Institute at College of Utah, advised Healio. “Moreover, particular affected person demographics or social determinants of well being could also be related to decreased charges of testing. These hypothesis-generating knowledge underscore the crucial for initiatives geared toward bridging these gaps.”
Background and strategies
Genomic profiling has allowed clinicians to deal with sufferers with metastatic prostate most cancers and superior urothelial carcinoma with focused therapies. This has translated to improved survival for each teams, in accordance with examine background.
For instance, 30% of males with superior prostate most cancers have BRCA or different homologous recombination restore alterations that may be handled with poly-ADP ribose polymerase inhibitors.
Chadi Hage Chehade
“A number of focused brokers are accepted for sufferers with metastatic prostate most cancers and superior urothelial carcinoma,” Hage Chehade stated. “Nevertheless, prior reviews have steered {that a} restricted variety of sufferers obtain next-generation sequencing (NGS) testing in real-world settings.”
One giant nationwide database confirmed low testing charges amongst sufferers with African (10.4%), Hispanic (9.1%) or East Asian (3.7%) ancestry, researchers wrote.
Hage Chehade and colleagues investigated NGS traits amongst sufferers with metastatic prostate most cancers or superior urothelial carcinoma. In addition they assessed disparities in testing charges.
They used the nationwide Flatiron Well being digital well being document database to assemble a cohort that included 18,417 people (median age, 73 years) identified with metastatic prostate most cancers or superior urothelial carcinoma between March 1, 2015, and Dec. 31, 2022.
The cohort included 11,927 males with prostate most cancers (66% white, 11.6% Black, 6.4% Hispanic or Latino) and 6,490 sufferers with urothelial carcinoma (73.4% males; 74.9% white; 4.8% Black; 4.4% Hispanic or Latino).
Outcomes and subsequent steps
Within the prostate most cancers subgroup, 29.3% of males underwent NGS (median time from analysis to sequencing, 13.2 months). Lower than half (43%) of males who acquired NGS underwent testing previous to first therapy.
Within the urothelial most cancers subgroup, 32% of people underwent NGS (median time from analysis to sequencing, 2.7 months). About half (51.3%) of people who acquired NGS underwent testing previous to second-line therapy.
Testing charges for males with prostate most cancers elevated from 19% in 2015 to 27.1% in 2022, with a single-year excessive of 36.1% in 2020. The cumulative incidence of testing by 1 yr after analysis rose from 1.3% in 2015 to 32.7% in 2022 (P < .001).
Nevertheless, probability of testing was considerably decrease amongst Black males (HR = 0.75; 95% CI, 0.67-0.84) and Hispanic or Latino males (HR = 0.7; 95% CI, 0.6-0.82) in contrast with white males.
Researchers additionally reported decrease testing charges amongst males within the two lowest quintiles of socioeconomic standing in contrast with these within the higher quintiles, males with Medicare or different authorities insurance coverage (HR = 0.89; 95% CI, 0.82-0.98) or Medicaid (HR = 0.53; 95% CI, 0.38-0.74) in contrast with personal well being plans, and males who lived within the West (HR = 0.81; 95% CI, 0.7-0.94) in contrast with these within the Midwest.
Within the urothelial most cancers cohort, testing charges elevated from 14.1% in 2015 to 46.6% in 2022, with a 1-year excessive of 48.8% in 2021. The cumulative incidence of testing by 1 yr after analysis rose from 6.9% in 2015 to 52.5% in 2022 (P < .001).
Subgroups within the urothelial most cancers cohort with decrease probability of NGS testing included Black sufferers (HR = 0.76; 95% CI, 0.61-0.96) in contrast with white sufferers, these with low socioeconomic standing vs. excessive, and people with Medicare or different authorities insurance coverage (HR = 0.88; 95% CI, 0.78-0.99) or Medicaid (HR = 0.72; 95% CI, 0.53-0.97) in contrast with those that had personal insurance coverage. People who lived within the South appeared extra prone to endure testing (HR = 1.29; 95% CI, 1.12-1.49) than those that lived within the Midwest.
“Well being care insurance policies are important to bettering testing charges in populations underrepresented in genomic testing,” Hage Chehade stated. “Some initiatives are already underway, such because the Nationwide Protection Willpower memorandum launched by Medicare in 2018, which categorized NGS as an important diagnostic instrument for sufferers with superior or metastatic most cancers [within CMS]. Nevertheless, for different populations, additional patient-centered and provider-centered initiatives are wanted. These might be achieved by way of affected person schooling, bettering entry to genetic testing, enhancing entry to genetic counselors and partnering with affected person advocacy teams.”
Researchers famous examine limitations, together with its retrospective nature and lack of differentiation between somatic and germline testing.
“It’s essential for clinicians to debate genetic testing with their sufferers as a result of NGS testing might uncover tumor alterations that may be focused by life-prolonging therapies,” Hage Chehade stated. “Moreover, NGS can help clinicians in prognostication and affected person counseling within the clinic and, in some instances, sufferers could also be eligible for enrollment in scientific trials primarily based on their genetic profile.”
For extra info:
Chadi Hage Chehade, MD, might be reached at [email protected].
Sources/Disclosures
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Disclosures:
Hage Chehade reviews no related monetary disclosures. Please see the examine for all different authors’ related monetary disclosures.
