To assess clinical actionability of mutations detected by MSK-IMPACT, we annotated sequence mutations, copy number alterations, and rearrangements according to OncoKB, a curated knowledge base of the oncogenic effects and treatment implications of somatic mutations (http://oncokb.org)40 . Mutations were classified in a tumor type-specific manner according to the level of evidence that the mutation is a predictive biomarker of drug response. Briefly, mutations were classified according to whether they are FDA-recognized biomarkers (Level 1), predict response to standard-of-care therapies (Level 2), or predict response to investigational agents in clinical trials (Level 3). Levels 2 and 3 were subdivided according to whether the evidence exists for the pertinent tumor type (2A, 3A) or a different tumor type (2B, 3B). Tumor samples were annotated according to the highest level of evidence for any mutation identified by MSK-IMPACT.
To determine the rate of enrollment to genomically matched clinical trials, we obtained a list of 850 clinical trials open at MSKCC on which any patient tested by MSK-IMPACT was ever enrolled up to September 2016. After reviewing the enrollment criteria and mechanism of action of each therapy, 197/850 clinical trials were deemed to have a target aberration. A patient was considered to be “matched” if he/she harbored at least one alteration considered to be a target for at least one clinical trial on which they were enrolled. Only patients whose tumors were sequenced during the first 18 months of the MSK-IMPACT sequencing initiative (prior to July 2015) were considered, given that utilization of molecular profiling results and changes to treatment regimens may not occur for many months (or longer) after testing. Of 5,009 patients tested by MSK-IMPACT prior to July 2015, 1,894 (38%) were enrolled on any clinical trial, 811 (16%) were enrolled on a clinical trial with a targeted agent, and 527 (11%) harbored genomic alterations matching the drug target. 72% of all matches occurred after the MSK-IMPACT reports were issued, with the remaining matches based on the results of prior molecular testing.
Clinical responses for patients receiving immunotherapy and targeted BRAF-directed therapy were assessed by detailed chart review. Response was defined as radiographic stable disease or tumor regression at or near 3 months from the initiation of therapy.
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