Advertisement


Neal D. Shore, MD, on Germline Genetic Testing and Its Impact on Prostate Cancer Clinical Decision-Making

2022 ASCO Annual Meeting

Advertisement

Neal D. Shore, MD, of the Carolina Urologic Research Center, discusses his study findings, showing that germline genetic testing influenced care for patients with prostate cancer. Men whose genetic test was positive for a pathogenic germline variant received more recommendations for changes to follow-up and treatment, and for testing and counseling of relatives, than did patients with negative or uncertain test results (Abstract 10500).

 



Transcript

Disclaimer: This video transcript has not been proofread or edited and may contain errors.
1,000 patients, prospectively analyzed for pathogenic variations via germline testing. That's what we did, 15 US urology sites, combining both community and academic sites. We presented our findings at ASCO 2021. At that point we revealed, in an oral podium presentation, that 50% of the PGVs, the pathogenic variants of germline, were within NCCN criteria and 50% were outside NCCN criteria. At ASCO 2022, we're presenting now the clinical considerations. What did our colleagues do with this information? Again, of note, 50% of the patients who received germline testing, would've fallen outside of NCCN criteria. This is important because we're really trying to democratize, and open up, germline testing to anyone with a diagnosis of prostate cancer. In our study, it included patients who had metastatic disease, biochemical relapse, newly diagnosed, prostate cancer. Furthermore, of our 1000 patients, 21% identified as nonwhite, so we had a very significant Black and Latino population. I think this is incredibly important given the ongoing themes of inclusion, equity, and disparity, which ASCO is promoting. Of note of our patients, 10% had pathogenic variants. Interestingly, it was around a discordance of 12% white and 4% in the black population, despite the 80-20% prevalence that we obtained. Now, interestingly, we had a two thirds higher number of patients in the black population who had alterations, gene alterations, of uncertain variations, or VUSs. This, I think, speaks to the fact that we've normalized VUS in a much greater way for the white population, not just in the US, but globally. Regarding the clinical considerations, our colleagues utilized clinical trials when there were PGVs that were found positive. The top five PGVs of the five, four out of the five were in DDR alterations. As we all know, we have PARP inhibitors and other findings that are actionable, certainly in the US, there's an FDA approval for PARP inhibition. Then another significant amount of patients went on to clinical trials. Remarkably and profoundly, more than two thirds of patients ultimately received referral to certified genetic counselors, or some form of genetic counseling, via telehealth, or from the sites themselves. There are certain limitations to our study in that it was a one shot time assessment. We are looking at longitudinal assessments. These were in urology community practices. It may be different at academic medical oncology sites, but what's important to note is that this had a very favorable, when we looked at questionnaires from the sites that participated, that they felt us, it was not only implementable, actionable, but also of great value for them as well as in the patient physician shared decision making.

Related Videos

Breast Cancer

Ann H. Partridge, MD, MPH, and Kevin Kalinsky, MD, on Breast Cancer: Latest Findings on Fulvestrant or Exemestane With or Without Ribociclib

Ann H. Partridge, MD, MPH, of Dana-Farber Cancer Institute, and Kevin Kalinsky, MD, of Winship Cancer Institute at Emory University, discuss phase II findings from the MAINTAIN trial, which showed a benefit in progression-free survival for patients with hormone receptor–positive/HER2-negative metastatic breast cancer when they switched to endocrine therapy and received ribociclib after disease progression on another CDK4/6 inhibitor (Abstract LBA1004).

Gynecologic Cancers

Ursula A. Matulonis, MD, and Nicoletta Colombo, MD, on Ovarian Cancer: Overall Survival Data on Relacorilant Plus Nab-Paclitaxel

Ursula A. Matulonis, MD, of Dana-Farber Cancer Institute, and Nicoletta Colombo, MD, of the University of Milan and the European Institute of Oncology, discuss phase II results on the overall survival benefit of intermittent relacorilant, a selective glucocorticoid receptor modulator, combined with nab-paclitaxel, compared with nab-paclitaxel alone in patients with recurrent platinum-resistant ovarian cancer. A phase III trial comparing intermittent relacorilant plus nab-paclitaxel with investigator’s choice of chemotherapy in primary platinum-refractory disease is ongoing (Abstract LBA5503).

Prostate Cancer

Alicia K. Morgans, MD, MPH, and Michael S. Hofman, MBBS, on Prostate Cancer: New Data on Lutetium-177–PSMA-617 (LuPSMA) vs Cabazitaxel

Alicia K. Morgans, MD, MPH, of Dana-Farber Cancer Institute, and Michael S. Hofman, MBBS, of Peter MacCallum Cancer Centre, University of Melbourne, discuss follow-up results on LuPSMA vs cabazitaxel in patients with metastatic castration-resistant prostate cancer progressing after docetaxel treatment. The findings suggest that LuPSMA is a suitable option for this population, with fewer adverse events, higher response rates, improved patient-reported outcomes, and similar overall survival compared with cabazitaxel (Abstract 5000).

Lung Cancer

Apar Kishor Ganti, MD, on SCLC: Comparing Quality of Life With Once- and Twice-Daily Thoracic Radiotherapy

Apar Kishor Ganti, MD, of the University of Nebraska Medical Center, discusses results from the CALGB 30610 study, which showed a similar clinical benefit for once- and twice-daily radiotherapy administered to patients with limited-stage small cell lung cancer. While both regimens were well tolerated, patients who received radiotherapy once daily had better quality-of-life scores at week 3 and slightly worse scores at week 12. Patients believed the once-daily regimen was more convenient (Abstract 8504).

Colorectal Cancer
Genomics/Genetics

Michael J. Overman, MD, and Smitha Krishnamurthi, MD, on RAS Wild-Type Metastatic Colorectal Cancer: Refining Treatment Strategy

Michael J. Overman, MD, of The University of Texas MD Anderson Cancer Center, and Smitha Krishnamurthi, MD, of the Cleveland Clinic, review three abstracts, all of which enrolled patients with newly diagnosed RAS and BRAF wild-type metastatic colorectal cancer with left-sided primary tumors. The discussion centers on what the study results indicate about the use of an EGFR therapy and weighing the risk to quality of life from rash, in particular (Abstracts LBA3503, LBA3504, LBA3505).

Advertisement

Advertisement




Advertisement