Physician Use of a Precision Oncology Decision Support Tool

09/28/17

A precision medicine support tool helps oncologists make clinical decisions and enroll patients in genotype-matched trials based on actionable mutations, according to a report published in JCO Precision Oncology (online September 13, 2017; doi:10.1200/PO.17.00036).

Precision oncology is in need of further decision support tools for determining the functional and therapeutic significance of genomic alterations in tumors, as well as relevant available options.

Funda Meric-Bernstam, MD, University of Texas MD Anderson Cancer Center, and colleagues convened a Precision Oncology Decision Support team to annotate genomic alterations and identify actionable alterations to subsequently determine whether clinical decision is influenced. Actionability was identified based on a mutation’s known or potential functional or therapeutic significance. Among the 2444 annotations from 669 patients, 32.5% of variants were deemed actionable, 9.4% potentially actionable, 29.7% unknown, and 28.4% non-actionable.

Researchers found that trial enrollment was significantly higher for patients with actionable or potentially actionable alterations (27.6%) than for those with unknown (11.8%) and nonactionable (3%) alterations (P < .001).

Among the most common genetic alterations that led to enrollment in trials were those in PTEN (n = 20), PIK3CA (n = 11), and ERBB2 (n = 10). Researchers acknowledged that physicians did not need decision support for evaluating the most common alterations; they were able to act on well-known variants without an interpretation by Precision Oncology Decision Support.

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Researchers reported 20.6% enrollment in genotype-matched trials, which they attributed to genotype-matched trials provided by Precision Oncology Decision Support in select reports, a larger portfolio of genotype-matched trials being offered at the MD Anderson Cancer Center, and email alerts directly to the physicians.

In their concluding remarks, researchers asserted that physicians are more likely to enroll a patient in a genotype-matched trial when an annotation supported actionability. “Further studies are needed to demonstrate the impact of decision support on trial enrollment and oncologic outcomes,” they wrote.—Zachary Bessette