Multitumor | Genomic Assays in the “Real” Oncology World — Part 1: Exploring the Role of Genomic Testing in Guiding Treatment for Patients with Advanced Breast, Colorectal and Prostate Cancers

published 1 week ago by Dr Neil Love

Genomic Assays in the “Real” Oncology World — Part 1: Genomic Assays and Colorectal Cancer — Featuring a roundtable discussion with Drs Emmanuel S Antonarakis, Johanna Bendell, Ian E Krop and Andrew McKenzie. Multiplex Genomic Assays and Their Role in Therapeutic Decision-Making Case: A man in his mid-80s with metastatic castration-resistant prostate cancer (mCRPC) whose disease progressed through multiple therapies is found to have CD274 (PD-L1) amplification, microsatellite instability (MSI)-high status and mutations in ATM and EGFR Effect of CD274 amplification on response to immune checkpoint inhibitors; activity of PARP inhibitors in patients with ATM mutations Advantages and limitations of multiplex genomic testing Role of serial testing to identify variations in genomic mutations or aberrations over time; potential benefit of liquid next-generation sequencing (NGS) panels Use of multiplex genomic assays by community oncologists and implications for clinical practice Optimal timing of genetic testing for patients diagnosed with metastatic disease Presentation (Dr McKenzie): Overview of multiplex genomic assay methodology Rationale for the use of serial testing and liquid assays to identify variations in genomic mutations or aberrations over time Differentiating between germline and somatic mutations in cancer tissue Perspective on the use of tissue versus liquid biopsy for genetic testing Sensitivity of liquid biopsies in detecting tumor mutations Available data exploring the impact of NGS use on patient outcomes Selection of a multiplex genomic assay for detecting genetic alterations Implications of multiplex genomic assay results for therapeutic decision-making Comprehensive Genetic Profiling and Precision Medicine for Metastatic Colorectal Cancer (mCRC) Specific biomarkers and genetic alterations routinely evaluated in clinical practice Effects of up-front multiplex genomic assay testing on outcomes for patients with mCRC Response to immune checkpoint inhibitors in patients with MSI-high mCRC (1:09:3s Presentation (Dr Bendell): Biomarker assessment in mCRC; role of multiplex testing Actionable genetic alterations in mCRC; detection of BRAF and HER2 mutations and implications for practice Rationale and indications for the assessment of MSI and DNA mismatch repair (MMR) status; emerging role of tumor mutational burden Role of liquid versus tumor biopsies for detecting genetic alterations MSI/MMR and tumor mutational burden as predictors of benefit from immune checkpoint inhibitors Emerging role for the assessment of neoantigen load Case (Dr Bendell): A man in his mid-50s with mCRC, Lynch syndrome and MSI-high status achieves a partial response to pembrolizumab as second-line therapy Case (Dr Bendell): A woman in her early 60s with microsatellite stable mCRC and a BRAF V600E mutation receives the combination of cetuximab, encorafenib and binimetinib after disease progression on FOLFOXIRI/bevacizumab Case (Dr Bendell): A man in his early 40s with HER2-positive mCRC receives trastuzumab and pertuzumab on a clinical trial after disease progression on FOLFIRI/bevacizumab and attains a partial response Novel HER2-targeted therapies under evaluation for patients with mCRC and HER2 alterations Analysis of the gut microbiome and strategies to enhance the immune response to cancer   CME information and select publications

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