Multigene Testing in Pancreatic Cancer: NCCN Impact
Hello. I'm Dr Maurie Markman, from City of Hope. I'd like to present a very interesting analysis. I think it's open to interpretation, and follow up of what I'm going to discuss is necessary, but I think it makes a number of important points relative to the question of optimal utilization o f multi-panel molecular testing as we move forward in this very exciting world of targeted therapy.
The paper is entitled, 'Utilization and outcomes of multigene panel testing in patients with pancreatic ductal adenocarcinoma.' This analysis was looking specifically at pancreas cancer and data that come from a Mayo Clinic analysis, from Mayo Clinic in Rochester, Arizona, and Florida.
They were looking at the utilization of multi-panel testing in a population of 533 patients with pancreas cancer before and after guideline recommendations from NCCN (National Comprehensive Cancer Network) that suggested such testing.
One of the advantages of the Mayo Clinic system is that the groups work very closely together.They have a really robust database. One would not know if the information in this report is comparable to other organizations, but I think it's very provocative to look at and for organizations that ask themselves, 'How are we doing with such testing?'
Of these 533 patients, 60% (321 patients) that they looked at in terms of the question of testing were before the NCCN recommendations, and 40% (212 patients) they looked at whether the testing was performed or whether a discussion was held with the patients and then testing performed. Again, they were looking at the electronic medical record after the recommendations.
Here's what they found: Prior to the NCCN recommendations — where doctors made their decisions based upon their knowledge of t he field, what they had read, meeting information, and CME programs — 34% of the patients had had a documented discussion regarding this testing. Of these, 81% — that's 81% of the population that had the discussion — had the test actually performed.
Post NCCN recommendations for the testing, that number increased minimally to 39%, of whom 75% of that population had the testing. WithNCCN recommendations, still only 40% of the patients had a discussion of the testing at the Mayo Clinic.
They noted that among the patients who did have testing, 17% had pathologic variants identified, of whom 11%, so 1 out of 10, had documented prostate cancer-related abnormalities that are potentially quite relevant for their treatment and also for discussions with their family.
This is a very important paper. It's a very important baseline, you might say. One must ask, how are we doing today? The implications of such testing are only greater compared to a year or two ago , both in terms of therapy and of course discussions with the family.
It's an interesting analysis and an important analysis.One can conclude that this is not so bad, considering it's new. You could say that we wished it would've been higher. I'd love to see a follow-up from Mayo Clinic. Where are they in 2024 or 2025?
Th ank you for your attention.
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