// Jean-François Laes 1 , Philippe Aftimos 2 , Philippe Barthelemy 3 , Joaquim Bellmunt 4, 5 , Guy Berchem 6 , Carlos Camps 7 , Ramón de las Peñas 8 , Ana Finzel 1 , Jesús García-Foncillas 9 , Petteri Hervonen 10 , Ibrahim Wahid 11 , Timo Joensuu 10 , Louis Kathan 12 , Anthony Kong 13 , James Mackay 14 , Christos Mikropoulos 15 , Kefah Mokbel 16 , Jean-Loup Mouysset 17 , Sergey Odarchenko 18 , Timothy J. Perren 19 , Rika Pienaar 12 , Carlos Regonesi 20 , Shadi Salem Alkhayyat 21 , Abdul Rahman El Kinge 22 , Omalkhair Abulkhair 22 , Khaled Morsi Galal 23 , Hady Ghanem 24 , Fadi El Karak 25 , Angel Garcia 26 , Gregori Ghitti 1 and Helen Sadik 1 1 OncoDNA SA, Office: 1, Rue Louis Breguet, Gosselies, Belgium 2 Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium 3 Hôpitaux Universitaires de Strasbourg, Strasbourg, France 4 Institut Hospital del Mar d’Investigacions Médiques, Barcelona, Spain 5 Harvard University, Cambridge, Massachusetts, USA 6 Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg 7 Consorcio Hospital General Universitario de Valencia, Valencia, Spain 8 Consorcio Hospitalario Provincial de Castellón, Castellón, Spain 9 Fundación Jimenez Díaz, IDC Salud, Madrid, Spain 10 Docrates Cancer Center, Helsinki, Finland 11 Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia 12 Cancercare, Cape Town, South Africa 13 University Hospital Birmingham NHS Trust, University of Birmingham, Edgbaston, UK 14 The London Breast Clinic, London, UK 15 Kent Oncology Centre, Kent, UK 16 The Princess Grace Hospital, London, UK 17 Clinique Rambot-Provençale, Aix-en-Provence, France 18 Vinnitsa Regional Clinical Oncology Center, Vinnitsa, Ukraine 19 St. James University Hospital, Leeds, UK 20 Clinica Las Condes, Santiago, Chile 21 King Abdulaziz University Hospital, Jeddah, Saudi Arabia 22 Specialized Medical Center Hospital, Riyadh, Saudi Arabia 23 Kasr El-Aini Hospital, Cairo University, Cairo, Egypt 24 Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon 25 Saint Joseph University, Hôtel-Dieu de France University Hospital, Beirut, Lebanon 26 Nuffield Hospital, Chester, UK Correspondence to: Jean-François Laes, email: jf.laes@oncodna.com Keywords: molecular profiling; solid tumour; precision medicine; next-generation sequencing; therapeutic decision making in oncology Received: December 20, 2017 Accepted: March 12, 2018 Published: April 17, 2018 ABSTRACT Molecular profiling and functional assessment of signalling pathways of advanced solid tumours are becoming increasingly available. However, their clinical utility in guiding patients’ treatment remains unknown. Here, we assessed whether molecular profiling helps physicians in therapeutic decision making by analysing the molecular profiles of 1057 advanced cancer patient samples after failing at least one standard of care treatment using a combination of next-generation sequencing (NGS), immunohistochemistry (IHC) and other specific tests. The resulting information was interpreted and personalized treatments for each patient were suggested. Our data showed that NGS alone provided the oncologist with useful information in 10–50% of cases (depending on cancer type), whereas the addition of IHC/other tests increased extensively the usefulness of the information provided. Using internet surveys, we investigated how therapy recommendations influenced treatment choice of the oncologist. For patients who were still alive after the provision of the molecular information (76.8%), 60.4% of their oncologists followed report recommendations. Most treatment decisions (93.4%) were made based on the combination of NGS and IHC/other tests, and an approved drug- rather than clinical trial enrolment- was the main treatment choice. Most common reasons given by physicians to explain the non-adherence to recommendations were drug availability and cost, which remain barriers to personalised precision medicine. Finally, we observed that 27% of patients treated with the suggested therapies had an overall survival > 12 months. Our study demonstrates that the combination of NGS and IHC/other tests provides the most useful information in aiding treatment decisions by oncologists in routine clinical practice.
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