Practice Update: Haematology & Oncology

CONFERENCE COVERAGE

14

American Society of Clinical Oncology annual meeting 2016 3–7 JUNE 2016 • CHICAGO, ILLINOIS, USA

The 2016 ASCO annual meeting was centred on the future of patient- centred care and research. In kicking off this year’s meeting, Dr Julie M. Vose, ASCO’s immediate-past president, called for collaboration among medical professionals in anticipation of providing care to increasing number of patients with cancer in the coming years. In this vein, many of the sessions this year were designed to provide information on the value of cancer care in conjuction with the scientific and medical information. A genomic classifier leads to better decision making about salvage radiotherapy for local prostate cancer recurrence Decision quality was improved with the use of a genomic classifier among patients considering sal- vage radiotherapy for local recurrence of prostate cancer after radical prostatectomy. T his conclusion, based on results of a prospective evalua- tion of the Decipher Prostate Cancer Classifier, has been published in the 2016 Annual Meeting Program of the American Society of Clinical Oncology. Dr John L. Gore, of the University of Washington, Seattle, explained that patients and providers experience tremendous uncertainty when deciding on the appropriate timing for in- tervention with salvage radiation therapy for suspected local recurrence after radical prostatectomy. Dr Gore and colleagues evaluated the impact of Decipher, a validated genomic classifier that predicts metastasis risk after radical prostatectomy, on urologists’ decision-making about salvage radiotherapy. Elai Davicioni, PhD, Chief Scientific Officer of GenomeDx Biosciences, said, “We undertook this study primarily to study how tumour genomic information from the Decipher Prostate Cancer Classifier would affect treatment decisions after radical prostatectomy. In addition, we determined the relationship between the risk of metastasis as determined by Decipher and patient-reported health related quality of life.” He continued, “After radical prostatectomy, men want to know if they are cured or require further treatment (that is, mul- timodal therapy). Physicians treating prostate cancer want to use genomic information, but only if this information changes what they would do or recommend. Such genomic information

management recommendations changed post Decipher, includ- ing 29% of Decipher low-risk patients and 65% of Decipher high-risk patients. Decisional Conflict Scale (DCS) scores decreased (indicat- ing higher decision quality), after exposure to Decipher results (median DCS pre-Decipher 28 [interquartile range 21–42] compared with 21 [interquartile range 2–28] post Decipher, P < 0.001). Dr Gore said that knowledge of Decipher results was as- sociated with treatment decision-making among patients with recurrence after radical prostatectomy. Patients found to be at low risk of metastasis by Decipher experienced higher rates of observation as the recommended treatment option. Patients at high risk experienced higher rates of recommendations for salvage radiotherapy. Dr Davicioni said, “The results showed numerous positive impacts of an accurate genomic assessment of metastasis risk. Significant changes in treatment were observed across both adjuvant and salvage arms. Decipher was the only significant risk factor that changed treatment in multivariable analysis and facilitated treatment decisions for both physicians and patients.” He added, “Finally, several health-related quality of life met- rics, urinary incontinence, for example, were shown to improve already, in this interim analysis, when Decipher-determined metastasis risk was available prior to decision-making. These results suggest that genomic information exerts a positive im- pact on functional outcomes.” Dr Davicioni, when asked about future directions, respond- ed, “We intend to further study how Decipher impacts clinical utility in other settings, such as in randomised trials, before surgery, and for practitioners such as radiation oncologists. Our goal is to develop level 1 evidence supporting appropriate use.”

incurs cost, in terms of both time and money. Ours was the first prospective study to evaluate both changes in treatment using genomic information in prostate cancer and patient-reported health related quality of life.” Seventy-five salvage patients were enrolled by 43 urologists from 19 community and academic practices. Patients with ris- ing PSA after radical prostatectomy were included. Physicians provided a management recommendation prior to ordering the Decipher Genomic test and again on receiving results. In the PRO-IMPACT trial, patients complete validated sur- veys on decision quality and prostate cancer-related anxiety and are followed for 1 year. Dr Gore and colleagues evaluated pre-and post-Decipher decision making in this interim analysis. Results were available for 69 patients. Median patient age at enrolment was 64 years; 45% had pathologic T3 stage clas- sification and 49.3% had positive surgical margins at radical prostatectomy. Median 5-year-predicted probability of metas- tases by Decipher was 5.9% (interquartile range 2.8–12.1%). Decipher classified 35%, 32%, and 33% as low, intermediate, and high risk, respectively. Without Decipher, 58%, 33%, and 8.7% of patients were recommended for observation, salvage radiotherapy, and other treatments, respectively. Thirty-nine percent (95% confidence interval 28–52%) of improve already, in this interim analysis, when Decipher-determined metastasis risk was available prior to decision-making. These results suggest that genomic information exerts a positive impact on functional outcomes. Finally, several health-related quality of life metrics, urinary incontinence, for example, were shown to

PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY