abstract
OBJECTIVE:
In
an effort to better incorporate precision medicine into clinical
practice, we initiated a pilot project to screen, discuss, and
genetically characterize patients with metastatic or recurrent
gynecologic malignancies for whom no curative standard of care exists.
METHODS:
In
7/2014, we initiated a multi-disciplinary Precision Medicine Board
(PMB) whose purpose was to apply molecular profiling to select and
prioritize early phase clinical trial enrollment for high-risk
gynecologic malignancies. Additional objectives were to record outcomes
and enable scientific discussions of mutations which may foster local
translational research. FoundationOne was the preferred genomic
platform; results were reviewed by a team comprised of disease site
specialists, phase I trialists, and basic and translational scientists
affiliated with the Gynecologic Cancer Program. A detailed database for
each patient was created and is followed prospectively for treatment use
and resultant outcomes.
RESULTS:
To
date, we have presented 62 cases with interpretable FoundationOne
testing on 60 tumor samples (
31 ovarian, 18 uterine, 9 cervical, and 4
other female genital tract). Significant genomic alterations were
commonly found in all tumor types (median: 3);
TP53 (45%) and
PIK3CA
(27%) were the most frequently noted mutations; however, molecular
profiling resulted in identification of few actionable mutations (6%).
To date,
we have matched 4 patients on therapies based on
actionable
mutations.
CONCLUSIONS:
The
predominant function of our PMB is establishment of a forum to enhance
research while providing clinical care for refractory malignancies. We
have matched patients with specific mutations to ongoing trials and are
developing investigator-initiated studies based on trends within genomic
profiling results. Longer-term follow up will be required to determine
the success of this strategy.
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