Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Pattern of access to genomically-linked therapies associated with pan-cancer biomarkers in advanced cancer patients: Insights from the Australian Molecular Screening and Therapeutics (MoST) Program (#255)

Christine E Napier 1 2 , Frank Lin 3 4 5 , Subo Thavaneswaran 3 4 6 , Lucille Sebastian 2 , John Grady 1 2 , Maya Kansara 7 , Milita Zaheed 1 4 , John Simes 3 , Mandy L Ballinger 1 2 , David M Thomas 1 2
  1. Centre for Molecular Oncology, UNSW, Sydney, NSW, Australia
  2. Omico, Sydney, NSW, Australia
  3. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
  4. School of Clinical Medicine, UNSW, Sydney, NSW, Australia
  5. Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia
  6. The Kinghorn Cancer Centre, St Vincent’s Hospital, Sydney, NSW, Australia
  7. Genomic Cancer Medicine Laboratory, Garvan Institute of Medical Research, Sydney, NSW, Australia

Aims: Genomics reveals links to tumour-agnostic drug therapies targeting actionable alterations not accessible through histotype-based treatment. However, real-world access to genomically-matched therapy in Australia remains unknown.

Methods: This cross-sectional study analysed therapy access after comprehensive genomic profiling (CGP) via the Molecular Screening and Therapeutics (MoST) program, a nationwide precision oncology platform. The study focused on rare and less common cancers (RLCC) and treatment-resistant solid tumours and reports the patient proportion with therapeutically significant genomic alterations, including high tumour mutational burden (TMB-H), microsatellite instability (MSI-H), BRAF V600E and oncogenic alterations in ERBB2, NTRK1-3 and RET, and access to molecular tumour board (MTB)-based therapy recommendations. Follow-up data cut-off was June 2024.

Results: From September 2016-December 2023, 7013 patients had valid CGP results through MoST. Of these, 4978 (71%) received an MTB recommendation. Among the 3704 patients (53%) who received systemic therapy after MTB issue, 1040 (28%) received a matched therapy. Notably, 640 of these patients (62%) accessed matched therapy(s) through clinical trials (351/640 MoST-affiliated, 55%). Similarly, 705 of 2644 RLCC patients received matched treatment, with 457 (65%) through clinical trials (260/457 MoST-affiliated, 57%). Trial participation for pan-cancer biomarkers ranged from 19-38%, with the most common drug classes being immunotherapy and inhibitors of BRAF V600E and RET (Table 1).

Conclusion: Matched therapy access linked to pan-cancer biomarkers is not universal following molecular profiling. Clinical trial participation is essential to address this access gap for Australian patients.

 

Table 1. Access pattern of therapies associated with pan-cancer biomarkers.

      Biomarker

   Frequency

      Received matched
      therapy post-CGP

     Trial participation (%)*

TMB-H

        828

                 424

                 206 (25)

MSI-H/instable

         75

                  23

                  14 (19)

BRAF V600E

        184

                  70

                  40 (22)

ERBB2 alteration

        372

                 109

                  73 (20)

NTRK fusion

         14

                  10

                   3 (21)

RET fusion

         24

                  16

                   9 (38)

*Relative to biomarker frequency

 

Supported by MSD, Merck Sharp & Dohme (Australia) Pty Limited