Genomic Profiling Guides mRCC Treatment

Clinicians have used comprehensive genomic profiling to inform treatment selection in patients with metastatic renal cell carcinoma (mRCC). Paulo Gustavo Bergerot, MD, and colleagues conducted a single-center study designed to determine whether genomic alterations guided treatment and were associated with improved outcomes.

Results of the study were reported during a poster session at the ASCO Quality Care Symposium in a poster titled Efficacy of Systemic Treatment for Metastatic Renal Cell Carcinoma (mRCC) Guided by Comprehensive Genomic Profiling (CGP).

Patients diagnosed with mRCC who had comprehensive genomic profiling in the course of clinical care eligible for the study. Patients were tested on a CLIAA-certified platform (Foundation One; Cambridge, MA). Exclusion criteria were death or hospice admission within 30 days after the administration of the test or loss to follow-up. Duration of therapy was defined as months between the first and last day of therapy following the comprehensive genomic profiling test. The association of comprehensive genomic profiling-directed therapy and overall survival was examined using the Kaplan-Meier method; Cox regression was performed and adjusted for histologic subgroup.

Between February 2014 and August 2018, 64 patients underwent comprehensive genomic profiling. Of those, 15 were excluded due to death or hospice admission within 30 days (n=10) or loss to follow-up (n=5). Median age was 60 years, 76% were male, and 69% were diagnosed with clear cell RCC.

The median number of identified genomic alterations was three; the most common were VHL (54%), PBRM1 (28%), TERT (21%), TP53 (15%), BAP1 (13%), and SETD2 (13%). Of the 49 patients included in the analysis, 47% had actionable mutations based on their CGP results. Of those 49 patients, 13 received directed-therapy; 57% had stable disease, 28% had partial response, and 14% had progressive disease.

Median time from comprehensive genomic profiling test to treatment was 1 month. Median duration of directed-therapy was 12 months; median duration of nondirected-therapy was 4 months. There was a significant association between directed-therapy and improved overall survival compared with nondirected therapy.

In conclusion, the researchers said, “This study provides preliminary evidence to justify comprehensive genomic profiling-guided therapy in mRCC. Forthcoming studies should prospectively explore the use of comprehensive genomic profiling in treatment allocation for mRCC to validate these findings.”

Source: Bergerot PG, Bergerot CD, Dizman N, Salgia N, Hsu J, Pal SK. Efficacy of systemic treatment for metastatic renal cell carcinoma (mRCC) guided by comprehensive genomic profiling (CGP). Abstract of a poster presented at the American Society of Clinical Oncology Quality Care Symposium, September 6, 2019, San Diego, California.