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Physicians Want More Education, Treatment Options for Future Tumor Genomic Profiling Trials

NEW YORK – Most physician participants expressed satisfaction with the care provided to patients enrolled in the National Cancer Institute's Molecular Analysis for Therapy Choice (MATCH) study, despite barriers like increased workload and long wait times for results, according to recently published survey results.

The survey was sent to more than 1,900 doctors participating in NCI-MATCH and received 171 responses, a response rate of 8.9 percent. Most respondents were both hematologists and oncologists or medical oncologists. It was conducted in October and November 2017, more than two years after the study began and after the study's initial screening portion was completed in May 2017. The survey results were published in JCO Precision Oncology last week.

The most common barriers physicians faced when considering a patient for NCI-MATCH were the wait times for test results (cited as always or often a barrier by 65 percent of respondents), that no action could be taken from the results (56 percent), and the total time a patient needed to be off treatment while waiting for results (48 percent).

"The results of our survey provide insight into the acceptability of the NCI-MATCH trial to investigators and identified areas for improvement for future tumor profiling studies," the authors wrote. "Given the potential for a change in the landscape and the complexity of the trial, features were built in from the outset to allow for maximal adaptability: an interim analysis after 500 patients, constant monitoring by a steering committee, and this survey to evaluate the acceptance of this trial by both the treating physician investigator and patients."

The researchers noted that NCI had previously identified wait time as an issue and added more staff to address it during the trial's preplanned pause. The authors wrote that the NCI-MATCH organizers attempted to address physicians' concerns around the lack of actionability from genetic test results by adding more treatment subprotocols in the study.

Results from the NCI-MATCH study, published Tuesday in the Journal of Clinical Oncology, showed that about 12 percent of approximately 5,500 sequenced cancer patients received treatment based on detected molecular tumor markers. The median time from the when labs received patients' samples to return of results was 16 days.

Other concerns physicians expressed in the survey included the increased workload and cost associated with the NCI-MATCH study. More than 70 percent of respondents said their work increased and 65 percent of respondents said costs increased while participating in the study.

For example, physicians participating in the trial had to spend more time discussing treatment options with patients. According to the survey, 56 percent said the time they spent discussing options with patients somewhat increased, while 18 percent indicated the time they spent doing this greatly increased.

"Placing patients in a trial such as NCI-MATCH definitely takes more time than referring them, but it also provides benefits such as allowing patients access to more treatment options on the basis of their tumor profile, continuity of care with their home oncologist, and the ability to receive treatment closer to home, potentially leading to greater satisfaction for both patients and oncologists," the authors wrote.

Despite the workload and cost, physicians reported increased satisfaction with care (57 percent), increased confidence in recommending a treatment (48 percent), and greater subsequent use of tumor profiling (70 percent).

The survey also explored whether physicians felt they needed more education or training. About half of the respondents said they needed more education about using tumor profiling results to guide decisions and 40 percent wanted education about how to determine whether tumor profiling is clinically appropriate for a patient.

Physicians also wanted more training on interpreting the next-generation sequencing report (40 percent) and explaining the results to their patients (40 percent).

In NCI-MATCH, researchers used an NGS test adapted from Thermo Fisher Scientific's Oncomine AmpliSeq panel that gauges 143 genes. Initially, patients' samples were sent for centralized testing at four labs: MD Anderson Cancer Center, Massachusetts General Hospital, Yale University, and the Frederick National Laboratory for Cancer Research. More recently, the study incorporated a lab qualification process that allowed for decentralized testing at more commercial and academic labs.

The other aim of the survey was to determine physicians' usual tumor profiling practices.

Nearly half of the respondents (45 percent) reported using tumor profiling in less than a quarter of their patients in the year prior to the survey. But when they did use tumor profiling, 65 percent said it was somewhat useful and 9 percent said it was very useful.

The most common scenario that prompted doctors to order tumor profiling was when they were treating a metastatic cancer patient without standard-of-care options (41 percent). About a quarter said they ordered profiling at the time of metastatic diagnosis and 14 percent ordered it when considering clinical trial enrollment.

When doctors were asked if they would consider participating in future cancer drug trials involving tumor profiling, at least 90 percent of doctors flagged access to targeted drugs, generation of evidence leading to treatment options, and identification of treatment options based on profiling as very important or extremely important motivators.

A majority of physicians said they would consider many factors when deciding whether to partake in future tumor genomic profiling trials, such as relevant patient inclusion criteria, a simple administrative process, a feasible testing process for all sites, design as a basket trial, coverage for test costs, the possibility of treating every patient in the trial, and allowing patients to receive some therapy as they wait for results.