Authors (including presenting author) :
Cheung KM(1), Wong CHL(2), Fong JKS(2), Lee V(2), Lim MY(3), Kam TY (4), Nyaw SF(5), Kwan CK(6), Mok F(7), Lee AWM(2), Yiu HHY(1)
Affiliation :
(1)Department of Clinical Oncology, Queen Elizabeth Hospital, (2)Department of Clinical Oncology, The University of Hong Kong, (3)Department of Oncology, Princess Margaret Hospital, (4)Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, (5)Department of Clinical Oncology, Tuen Mun Hospital, (6)Department of Oncology, United Christian Hospital, (7)Department of Clinical Oncology, Prince of Wales Hospital
Introduction :
Lung cancer is one of the most aggressive cancers worldwide. In 2020, there were approximately 5400 new cases of lung cancer in Hong Kong. Recent development in lung cancer included discovering multiple targetable oncogenic driver genes and their corresponding therapeutic agents. While usual management algorithm included sequencing of individual genes or a small panel of actionable target genes, using comprehensive genomic profiling (CGP) will enable complete understanding of currently actionable, emerging, and prognostic genes at one go, thus reducing the turnaround time for sequential testing and providing clinicians with the best insights. The HKU-Hospital Authority (HA) lung cancer CGP project provides all eligible advanced lung cancer patients with CGP testing since 2021.
Objectives :
To report the feasibility of the novel diagnostic approach.
Methodology :
The HKU-HA lung cancer CGP project provides a total of 1800 CGP tests for all eligible advanced lung cancer patients. The feasibility of new service model of CGP in advanced lung cancer is assessed. Changes in mutation detected for CGP compared to standard assay were reported in percentages. Clinician-assessed impact on workflow and satisfaction were reported.
Result & Outcome :
As of August 2023, 432 patients have been enrolled to the CGP project, with 84 patients in HKWC, 70 in HKEC, 24 in KEC, 42 in KWC, 70 in KCC, 52 in NTEC and 90 in NTWC respectively. 32.6% of patients were identified to have mutations in HA standard assay, and 65.3% of patients were identified to have druggable mutation in CGP. CGP improved detection of druggable mutation by double compared to HA standard assay. In addition, 72.5% of patients were noted to have other important cancer-associated mutations which could be of predictive and prognostic importance. For clinician survey, all participating clinicians are willing to adapt the new CGP approach. 85.7% of clinicians opined that the additional information could improve therapy prescription, 95.2% expressed improvement in prediction of treatment effect and 81% think that it helps with prognostication. Both the mean estimated additional time needed to explain the project details to patients and the mean estimated time to be spent on obtaining informed consent from patients to join the programme are 7.6 minutes. The introduction of novel CGP testing into HA service model is effective in managing advanced lung cancer patients amidst the increasingly complex molecular-directed treatment landscape.
