Authors: Diya Garg, Chadi Hage Chehade, Yeonjung Jo, Georges Gebrael, Nishita Tripathi, Beverly Chigarira, Arshit Narang, Vinay Matthew Thomas, Gliceida Galarza Fortuna, Patrick Campbell, Clara Tandar, Ayana Srivastava, Nicolas Sayegh, Sumati Gupta, Benjamin L. Maughan, Soumyajit Roy, Neeraj Agarwal, Umang Swami
Mentors: Neeraj Agarwal
Insitution: University of Utah
Trends in tumor NGS genomic testing at diagnosis of metastatic prostate cancer (mPC) and urothelial carcinoma (mUC)
Diya Garg1, Chadi Hage Chehade1, Yeonjung Jo1, Georges Gebrael1, Nishita Tripathi1, Beverly Chigarira1, Arshit Narang1, Vinay Matthew Thomas1, Gliceida Galarza Fortuna1, Patrick Campbell1, Clara Tandar1, Ayana Srivastava1, Nicolas Sayegh1, Sumati Gupta1, Benjamin L. Maughan1, Soumyajit Roy1, Neeraj Agarwal1, Umang Swami1
1Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT;
Objectives: Next-generation sequencing (NGS) can allow receipt of approved targeted therapies and recruitment into clinical trials and aid with prognostication and response to therapy. In mPC, the presence of homologous recombination repair (HRR) alterations can render patients (pts) eligible for PARP inhibitor therapies [PMID: 37442702]. In mUC, genomic alterations in FGFR3 or FGFR2 can make them eligible for erdafitinib [PMID: 31340094]. Multiple agents have tumor agnostic approvals for molecular specific alterations. Herein, we aim to analyze the current trends in NGS testing in both mPC and mUC.
Methods: A de-identified nationwide Flatiron Health Electronic Health Record (EHR)-derived database was used to extract pt-level data. Eligibility: pts diagnosed with mPC or mUC and receiving treatment for their disease between March 2015 and December 2022. The NGS test was considered performed at diagnosis if completed within a year of the initial metastatic disease diagnosis. A two-sided 95% confidence interval (CI) was calculated using Clopper and Pearson method. The analysis was done using R version 4.2.3.
Results: The study included 11,936 and 6,340 pts in the mPC and mUC cohorts, respectively. For mPC, the rate of NGS testing among men in 2015 was only 1.3% (95% CI 0.7-2.1%). This rate steadily increased, plateauing between 2021 and 2022 at 28% (95% CI 25.8-30.3%) and 27.1% (95% CI 24.5-29.8%), respectively. NGS testing was mainly performed on samples from primary prostate tissue (46.1%), followed by blood (32.8%) and saliva (0.1%) or from any of these 3 sites (2.9%). In the mUC cohort, the rate of testing among pts in 2015 was 6.7% (95% CI 4.8-8.9%). However, by 2021 and 2022, the rates had improved, reaching 46.8% (95% CI 43.5 – 50.2%) and 46.5% (95% CI 42.5-50.5%), respectively. Samples for NGS testing were mainly obtained from primary bladder tissue (72.8%), followed by blood (15.6%), or from both sites (0.2%). The sample source for testing was unknown in 18.1% and 11.4% of cases in mPC and mUC, respectively.
Conclusions: In this large real-world analysis, we show that while the rate of NGS testing has improved over time, the majority of pts do not undergo NGS testing in both mPC and mUC cohorts. Addressing barriers to NGS testing remains an unmet need. Incorporating tumor genomic testing into the standard of care management can optimize treatment selection, prognostication, and access to clinical trials.
Table 1. Rate of NGS testing by metastatic diagnosis year and Clopper and Pearson 95% CI in mPC and mUC
Metastatic diagnosis year. 2015 2016 2017 2018 2019 20202021 2022
mPC cases (N) 1224 1587 1529 1583 1726 1594 1572 1121
mPC NGS rate (%) 1.3 (0.7 – 2.1) 3.7 (2.8 – 4.8)7.2 (5.9 – 8.6) "8.3 (7 –
9.8)" 14.6 (13 – 16.4) 22.8 (20.8 – 25) 28 (25.8 – 30.3) 27.1 (24.5 – 29.8)
mUC cases (N) 630 808 901 877 880 910 873 611
mUC NGS rate (%) 6.7 (4.8 – 8.9) 9.2 (7.3 – 11.4) 11.9 (9.8 – 14.2) 18.1 (15.6 – 20.8) 29.4 (26.4 – 32.6) 40.5 (37.3 – 43.8) 46.8 (43.5 – 50.2) 46.5 (42.5 – 50.5)