Single-Institution Study of Next-Generation Sequencing Outcomes in Patients With Cancer


Key Points

  • Among usable NGS reports, 90% showed actionable aberrations.
  • NGS reports resulted in management changes in 11.1% of patients.

In a single-institution retrospective study reported in the Journal of Oncology Practice, Davis and colleagues found that next-generation sequencing (NGS) tests resulted in changes in management in a small proportion of patients with cancer.

Study Details

The study involved retrospective review of data from 305 consecutive patients at MD Anderson at Cooper University Hospital (Camden, New Jersey) who had NGS testing of tumor samples between March 2014 and April 2017. NGS testing was ordered at the discretion of individual physicians. Tests using circulating tumor DNA were not available during the study period. Patients had received an average of two lines of chemotherapy; 87.5% had metastatic disease, with NGS testing being performed an average of 1.1 years after diagnosis of metastatic disease.

NGS Results and Changes in Management

Of the 305 patient samples sent for NGS analysis, a total of 189 reports (62.0% of patients) were potentially usable. A total of 52 samples did not yield a report due to insufficient quantity of tissue (n = 43), order cancellation (n = 4), or unknown reasons (n = 5); an additional 64 reports (21.0%) were not used because the patient was lost to follow-up, stopped receiving treatment after transfer to hospice, or died.

Among the 189 usable reports, 170 (89.9%) showed actionable aberrations, including 76 with aberrations targetable with on-label therapies, 66 with aberrations targetable by off-label therapies, and 28 targetable only in clinical trials. Overall, 21 reports (11.1%) resulted in a change in management, including use of on-label therapies in seven patients, use of off-label therapies in six patients, enrollment in a clinical trial for six patients, and discontinuation of a treatment with predicted poor response in three patients. Among the six patients receiving off-label treatment, median duration of treatment was 46 days, with discontinuation occurring due to death in three and disease progression in three.

The investigators concluded: “Only a minority of NGS assay results (6.9% percent of all tests ordered and 11.1% of usable tests) resulted in a management change. A small minority of patients started off-label therapy on the basis of [NGS] assay results, and overall, had poor responses to off-label treatment. Although in theory NGS assays may improve oncologic outcomes, the results of our initial 305 patients showed low clinical utility.”

Gregory J. Kubicek, MD, of MD Anderson at Cooper University Hospital, Department of Radiation Oncology, is the corresponding author for the Journal of Oncology Practice article.

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