RESUMEN
PURPOSE: There is limited information about the clinical utility of targeted next-generation sequencing (NGS) panel testing to inform decision making for patients with advanced solid tumors. The Ontario-wide Cancer Targeted Nucleic Acid Evaluation (OCTANE) is a prospective study that enrolled more than 4,500 patients with solid tumor for NGS panel testing. We performed a retrospective survey of medical oncologists to evaluate the impact of NGS testing on treatment decisions. METHODS: Patients and treating oncologists were identified at the Princess Margaret Cancer Center between 2016 and 2021. Tumor-only sequencing was performed using a gene panel of either 555 or 161 cancer genes. Oncologists were asked to review testing results and complete a survey indicating whether NGS testing affected treatment decisions. The primary outcome of this study was rate of treatment change on the basis of mutation results. Patient, test, and physician factors were evaluated for association with treatment changes using univariate analyses and a mixed-effects model. RESULTS: Of the 582 surveys sent, 394 (67.7%) were completed. We found that 188 (47.7%) patients had testing results classified as actionable by the oncologist and 62 (15.7%) patients were matched to treatment, of whom 37 (60%) were enrolled in a clinical trial, 13 (21%) received an approved drug, four (6%) were prescribed off-label therapy, and eight (13%) avoided ineffective treatment. Patient, test, and physician characteristics were not significantly associated with treatment change. There was no difference in overall survival between patients who received matched treatment versus those who did not (P = .55, median survival not reached). CONCLUSION: OCTANE testing led to a change in drug treatment in 15.7% of patients, supporting the clinical utility of NGS panel testing for patients with advanced solid tumors.
Asunto(s)
Secuenciación de Nucleótidos de Alto Rendimiento , Neoplasias , Centros de Atención Terciaria , Humanos , Neoplasias/genética , Neoplasias/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Toma de Decisiones Clínicas , Adulto , Ontario , Estudios ProspectivosRESUMEN
CONTEXT: Researchers have confirmed that the ruler-drop test could be included as part of a multifaceted concussion-assessment battery and potentially as a way to track recovery from head injury. However, it is unclear if this clinical test of reaction time would be characterized by inconsistent performance because of practice effects. OBJECTIVE: To determine if the ruler-drop test is susceptible to practice effects after serial administration. DESIGN: Descriptive laboratory study. SETTING: Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS: Forty-three persons (age = 21.8 ± 2.6 years). INTERVENTION(S): Ten sessions were completed over 5 weeks. Participants completed 10 trials of the ruler-drop test during each session. MAIN OUTCOME MEASURE(S): The mean reaction times calculated for all participants from each test session were analyzed to determine if there was any meaningful change (ie, improvement) in reaction time over the course of the investigation. RESULTS: Simple reaction time improved (ie, decreased) after repeated administration of the ruler-drop test, and the most pronounced improvement occurred between the first 2 test sessions. Between the first and second test sessions, reaction time decreased by almost 7 milliseconds, and there was an overall improvement of almost 13 milliseconds between the first and tenth sessions. Although the pairwise comparisons between the first and second and the first and third sessions were not significant, the change in mean reaction time between the first session and most of the other sessions was significant. We noted no differences when successive sessions were compared. CONCLUSIONS: To prevent practice-related improvements in reaction time, practitioners should allow at least 1 practice session before recording baseline results on the ruler-drop test.