Advanced cancer patients have better outcomes when therapy is genomically- guided

In patients with refractory metastatic cancers, genomically-guided therapy may bring about better outcomes, according to a study published online July 15 in the journal Oncotarget. This is possible because such therapies work to match the specific “acquired genetic mistake present in the tumor” with agents targeted specifically to these vulnerabilities, concluded these researchers.  

"While there has been incredible enthusiasm for use of genomics to help guide patients to personalized therapy, there still needs to be additional evidence that this approach helps patients," said senior author Bryan Schneider, MD, associate professor of medicine and the Vera Bradley Investigator in Oncology, and also a researcher at the Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.

"What we already know across cancer types is that for each subsequent line of therapy, a patient can expect a shorter amount of time to experience benefit from the therapy. We looked at the percentage of patients who actually beat their prior line of therapy in terms of success. This allowed us to really use each patient as his or her own benchmark," he explained.

For this study, Dr. Schneider and colleagues included 101 patients from the Indiana University Health precision genomics program from April 2014 through October 2015 who had metastatic solid tumors and had progressed on at least one line of therapy. They had patient tumor samples analyzed via DNA and RNA next-generation sequencing, and found that most had soft tissue sarcoma, breast cancer, pancreatic cancer, or colorectal cancer.

In all, 43.2% of patients who received genomically-guided therapy exhibited a progression-free survival (PFS) ratio of ≥ 1, which was significantly better compared with not only their own previous treatment, but with the 5.3% of patients treated with non-genomically guided therapy (P < 0.0001). In addition, overall PFS ratios were higher for patients who received genomically-guided therapy compared with those who did not (P=0.05), as were median PFS values (86 days vs 49 days, respectively; HR: 0.55, 95% CI: 0.37-0.84; P=0.005).

Thus, concluded the authors, given their results and the growing number of studies showing better outcomes in patients treated with genomic-guided therapies, clinicians should consider this approach in the appropriate patients to achieve optimal therapy or guide patients to clinical trials best suited to their specific needs.

"This study gives us evidence in a real clinical world with patients with a variety of tumors who are getting a variety of therapies–both on and off clinical protocol–that they do indeed gain a benefit,” concluded Dr. Schneider.

This study was funded, in part, by a grant from the Walther Cancer Foundation.