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Vashistha V, Poonnen PJ, Snowdon JL, Skinner HG, McCaffrey V, Spector NL, Hintze B, Duffy JE, Weeraratne D, Jackson GP, Kelley MJ, Patel VL. Medical oncologists' perspectives of the Veterans Affairs National Precision Oncology Program. PLoS One 2020; 15:e0235861. [PMID: 32706774 PMCID: PMC7380614 DOI: 10.1371/journal.pone.0235861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To support the rising need for testing and to standardize tumor DNA sequencing practices within the U.S. Department of Veterans Affairs (VA)'s Veterans Health Administration (VHA), the National Precision Oncology Program (NPOP) was launched in 2016. We sought to assess oncologists' practices, concerns, and perceptions regarding Next-Generation Sequencing (NGS) and the NPOP. MATERIALS AND METHODS Using a purposive total sampling approach, oncologists who had previously ordered NGS for at least one tumor sample through the NPOP were invited to participate in semi-structured interviews. Questions assessed the following: expectations for the NPOP, procedural requirements, applicability of testing results, and the summative utility of the NPOP. Interviews were assessed using an open coding approach. Thematic analysis was conducted to evaluate the completed codebook. Themes were defined deductively by reviewing the direct responses to interview questions as well as inductively by identifying emerging patterns of data. RESULTS Of the 105 medical oncologists who were invited to participate, 20 (19%) were interviewed from 19 different VA medical centers in 14 states. Five recurrent themes were observed: (1) Educational Efforts Regarding Tumor DNA Sequencing Should be Undertaken, (2) Pathology Departments Share a Critical Role in Facilitating Test Completion, (3) Tumor DNA Sequencing via NGS Serves as the Most Comprehensive Testing Modality within Precision Oncology, (4) The Availability of the NPOP Has Expanded Options for Select Patients, and (5) The Completion of Tumor DNA Sequencing through the NPOP Could Help Improve Research Efforts within VHA Oncology Practices. CONCLUSION Medical oncologists believe that the availability of tumor DNA sequencing through the NPOP could potentially lead to an improvement in outcomes for veterans with metastatic solid tumors. Efforts should be directed toward improving oncologists' understanding of sequencing, strengthening collaborative relationships between oncologists and pathologists, and assessing the role of comprehensive NGS panels within the battery of precision tests.
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Affiliation(s)
- Vishal Vashistha
- Department of Veterans Affairs, National Precision Oncology Program, Durham, NC, United States of America
- Duke Cancer Institute, Durham, NC, United states of America
- Department of Hematology and Oncology, Durham Veterans Affairs Medical Center, Durham, NC, United States of America
| | - Pradeep J. Poonnen
- Department of Veterans Affairs, National Precision Oncology Program, Durham, NC, United States of America
- Duke Cancer Institute, Durham, NC, United states of America
- Department of Hematology and Oncology, Durham Veterans Affairs Medical Center, Durham, NC, United States of America
| | | | - Halcyon G. Skinner
- College of Health, Lehigh University, Bethlehem, PA, United States of America
| | | | - Neil L. Spector
- Department of Veterans Affairs, National Precision Oncology Program, Durham, NC, United States of America
- Duke Cancer Institute, Durham, NC, United states of America
- Department of Hematology and Oncology, Durham Veterans Affairs Medical Center, Durham, NC, United States of America
| | - Bradley Hintze
- Department of Veterans Affairs, National Precision Oncology Program, Durham, NC, United States of America
| | - Jill E. Duffy
- Department of Veterans Affairs, National Precision Oncology Program, Durham, NC, United States of America
| | | | - Gretchen P. Jackson
- Watson Health, IBM, Cambridge, MA, United States of America
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Michael J. Kelley
- Department of Veterans Affairs, National Precision Oncology Program, Durham, NC, United States of America
- Duke Cancer Institute, Durham, NC, United states of America
- Department of Hematology and Oncology, Durham Veterans Affairs Medical Center, Durham, NC, United States of America
| | - Vimla L. Patel
- Center for Cognitive Sciences in Medicine and Public Health, The New York Academy of Medicine, New York City, NY, United States of America
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Haspel RL, Ali AM, Huang GC, Smith MH, Atkinson JB, Chabot-Richards DS, Elliott RM, Kaul KL, Powell SZ, Rao A, Rinder HM, Vanderbilt CM, Wilcox R. Teaching Genomic Pathology: Translating Team-Based Learning to a Virtual Environment Using Computer-Based Simulation. Arch Pathol Lab Med 2018; 143:513-517. [PMID: 30500295 DOI: 10.5858/arpa.2018-0153-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Developing skills related to use of computer-based tools is critical for practicing genomic pathology. However, given the relative novelty of genomics education, residency programs may lack faculty members with adequate expertise and/or time to implement training. A virtual team-based learning (TBL) environment would make genomic pathology education available to more trainees. OBJECTIVE.— To translate an extensively implemented in-person TBL genomic pathology workshop into a virtual environment and to evaluate both knowledge and skill acquisition. DESIGN.— Using a novel interactive simulation approach, online modules were developed translating aspects of the TBL experience into the virtual environment with a goal of acquisition of necessary computer-related skills. The modules were evaluated at 10 postgraduate pathology training programs using a pre-post test design with participants deidentified. A postmodule anonymous survey obtained participant feedback on module quality and efficacy. RESULTS.— There were 147 trainees who received an email request to voluntarily participate in the study. Of these, 43 trainees completed the pretest and 15 (35%) subsequently completed the posttest. Mean overall scores were 45% on the pretest compared with 70% on the posttest ( P < .001; effect size = 1.4). Posttest improvement of results was similar for questions testing acquisition of knowledge versus skills. Regarding the 19 participants who took the survey, 18 (95%) would recommend the modules to others and believed they met the stated objectives. CONCLUSIONS.— A simulation-based approach allows motivated pathology trainees to acquire computer-related skills for practicing genomic pathology. Future work can explore efficacy in a nonvoluntary setting and adaptation to different specialties, learners, and computer tools.
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Affiliation(s)
- Richard L Haspel
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Asma M Ali
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Grace C Huang
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Matt H Smith
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - James B Atkinson
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Devon S Chabot-Richards
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Robin M Elliott
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Karen L Kaul
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Suzanne Z Powell
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Arundhati Rao
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Henry M Rinder
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Chad M Vanderbilt
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
| | - Rebecca Wilcox
- From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain
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Rangachari D, VanderLaan PA, Le X, Folch E, Kent MS, Gangadharan SP, Majid A, Haspel RL, Joseph LJ, Huberman MS, Costa DB. Experience with targeted next generation sequencing for the care of lung cancer: insights into promises and limitations of genomic oncology in day-to-day practice. ACTA ACUST UNITED AC 2015; 4:174-181. [PMID: 26601054 DOI: 10.1016/j.ctrc.2015.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Tumor genotyping using single gene assays (SGAs) is standard practice in advanced non-small-cell lung cancer (NSCLC). We evaluated how the introduction of next generation sequencing (NGS) into day-to-day clinical practice altered therapeutic decision-making. METHODS Clinicopathologic data, tumor genotype, and clinical decisions were retrospectively compiled over 6 months following introduction of NGS assay use at our institution in 82 patient-tumor samples (7 by primary NGS, 22 by sequential SGAs followed by NGS, and 53 by SGAs). RESULTS SGAs identified abnormalities in 34 samples, and all patients with advanced EGFR-mutated or ALK-rearranged tumors received approved tyrosine kinase inhibitors (TKIs) or were consented for clinical trials. NGS was more commonly requested for EGFR, ALK, and KRAS-negative tumors (p<0.0001). NGS was successful in 24/29 (82.7%) tumors. Of 17 adenocarcinomas (ACs), 11 (7 from patients with ≤15 pack-years of smoking) had abnormalities in a known driver oncogene. This led to a change in decision-making in 8 patients, trial consideration in 6, and off-label TKI use in 2. Of 7 squamous cell (SC) carcinomas, 1 had a driver aberration (FGFR1); 6 had other genomic events (all with TP53 mutations). In no cases were clinical decisions altered (p=0.0538 when compared to ACs). CONCLUSIONS Targeted NGS can identify a significant number of therapeutically-relevant driver events in lung ACs; particularly in never or light smokers. For SC lung cancers, NGS is less likely to alter current practice. Further research into the cost effectiveness and optimal use of NGS and improved provider training in genomic oncology are warranted.
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Affiliation(s)
- Deepa Rangachari
- Department of Medicine, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Paul A VanderLaan
- Department of Pathology, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Xiuning Le
- Department of Medicine, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Erik Folch
- Department of Medicine, 330 Brookline Avenue, Boston, MA 02215, USA ; Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA; all at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael S Kent
- Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA; all at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sidharta P Gangadharan
- Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA; all at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adnan Majid
- Department of Medicine, 330 Brookline Avenue, Boston, MA 02215, USA ; Department of Surgery, 330 Brookline Avenue, Boston, MA 02215, USA; all at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard L Haspel
- Department of Pathology, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Loren J Joseph
- Department of Pathology, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Mark S Huberman
- Department of Medicine, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Daniel B Costa
- Department of Medicine, 330 Brookline Avenue, Boston, MA 02215, USA
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