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Lee B, Tran B, Hsu AL, Taylor GR, Fox SB, Fellowes A, Marquis R, Mooi J, Desai J, Doig K, Ekert P, Gaff C, Herath D, Hamilton A, James P, Roberts A, Snyder R, Waring P, McArthur G. Exploring the feasibility and utility of exome-scale tumour sequencing in a clinical setting. Intern Med J 2018; 48:786-794. [PMID: 29607586 DOI: 10.1111/imj.13806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Technology has progressed from single gene panel to large-scale genomic sequencing. This is raising expectations from clinicians and patients alike. The utility and performance of this technology in a clinical setting needs to be evaluated. AIM This pilot study investigated the feasibility of using exome-scale sequencing (ESS) to identify molecular drivers within cancers in real-time for Precision Oncology in the clinic. METHODS Between March 2014 and March 2015, the Victorian Comprehensive Cancer Centre Alliance explored the feasibility and utility of ESS in a pilot study. DNA extracted from the tumour specimens underwent both ESS and targeted 'hotspot' sequencing (TS). Blood was taken for germline analysis. A multi-disciplinary molecular tumour board determined the clinical relevance of identified mutations; in particular, whether they were 'actionable' and/or 'druggable'. RESULTS Of 23 patients screened, 15 (65%) met the tissue requirements for genomic analysis. TS and ESS were successful in all cases. ESS identified pathogenic somatic variants in 73% (11/15 cases) versus 53% (8/15 cases) using TS. Clinically focused ESS identified 63 variants, consisting of 30 somatic variants (including all 13 identified by TS) and 33 germline variants. Overall, there were 48 unique variants. ESS had a clinical impact in 53% (8/15 cases); 47% (7/15 cases) were referred to the familial cancer clinic, and 'druggable' targets were identified in 53% (8/15 cases). CONCLUSION ESS of tumour DNA impacted clinical decision-making in 53%, with 20% more pathogenic variants identified through ESS than TS. The identification of germline variants in 47% was an unexpected finding.
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Affiliation(s)
- Belinda Lee
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Systems Biology and Personalized Medicine, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Systems Biology and Personalized Medicine, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Arthur L Hsu
- Centre for Translational Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Graham R Taylor
- Centre for Translational Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen B Fox
- Department of Molecular Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Fellowes
- Department of Molecular Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Renata Marquis
- Centre for Translational Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Mooi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jayesh Desai
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Systems Biology and Personalized Medicine, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Ken Doig
- Department of Molecular Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Paul Ekert
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Clara Gaff
- Melbourne Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Dishan Herath
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia
| | - Anne Hamilton
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Gynaecological Oncology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Paul James
- Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Roberts
- Clinical Translation Centre, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Ray Snyder
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Paul Waring
- Centre for Translational Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant McArthur
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, St Vincent's Hospital, Melbourne, Victoria, Australia
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