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Title: Genomic Analysis of Metastatic Solid Tumors in Veterans: Findings From the VHA National Precision Oncology Program

Abstract

The Veterans Health Administration (VHA) is the largest cancer care provider in the United States, with the added challenge of serving more than twice the percentage of patients with cancer in rural areas than the national average. The VHA established the National Precision Oncology Program in 2016 to implement and standardize the practice of precision oncology across the diverse VHA system.METHODSTumor or peripheral blood specimens from veterans with advanced solid tumors who were eligible for treatment were submitted for next-generation sequencing (NGS) at two commercial laboratories. Annotated results were generated by the laboratories and independently using IBM Watson for Genomics. Levels-of-evidence treatment recommendations were based on OncoKB criteria.RESULTSFrom July 2016 to June 2018, 3,698 samples from 72 VHA facilities were submitted for NGS testing, of which 3,182 samples (86%) were successfully sequenced. Most samples came from men with lung, prostate, and colorectal cancers. Thirty-four percent of samples were from patients who lived in a rural area. TP53, ATM, and KRAS were among the most commonly mutated genes. Approximately 70% of samples had at least one actionable mutation, with clinical trials identified as the recommended option in more than 50%. Mutations in genes associated with a neuroendocrine prostate cancer phenotype weremore » expressed at increased frequency among veterans than in the general population. The most frequent therapies prescribed in response to NGS testing were immune checkpoint inhibitors, EGFR kinase inhibitors, and PARP inhibitors.CONCLUSIONClinical implementation of precision oncology is feasible across the VHA health care system, including rural sites. Veterans have unique occupational exposures that might inform the nature of the mutational signatures identified here. Importantly, these results underscore the importance of increasing clinical trial availability to veterans.« less

Authors:
; ; ; ; ; ; ; ; ; ; ;
Publication Date:
Research Org.:
Argonne National Lab. (ANL), Argonne, IL (United States)
Sponsoring Org.:
USDOE Office of Science (SC), Basic Energy Sciences (BES) (SC-22); U.S. Department of Veterans Affairs
OSTI Identifier:
1570967
DOE Contract Number:  
AC02-06CH11357
Resource Type:
Journal Article
Journal Name:
JCO Precision Oncology
Additional Journal Information:
Journal Volume: 3
Country of Publication:
United States
Language:
English

Citation Formats

Poonnen MD, Pradeep J., Duffy, Jill E., Hintze, Bradley, Shukla, Maulik, Brettin, Thomas S., Conrad, Neal R., Yoo, Hyunseung, Guertin, Christopher, Looney, Jane A., Vashistha, Vishal, Kelley MD, Michael J., and Spector MD, Neil L. Genomic Analysis of Metastatic Solid Tumors in Veterans: Findings From the VHA National Precision Oncology Program. United States: N. p., 2019. Web. doi:10.1200/PO.19.00075.
Poonnen MD, Pradeep J., Duffy, Jill E., Hintze, Bradley, Shukla, Maulik, Brettin, Thomas S., Conrad, Neal R., Yoo, Hyunseung, Guertin, Christopher, Looney, Jane A., Vashistha, Vishal, Kelley MD, Michael J., & Spector MD, Neil L. Genomic Analysis of Metastatic Solid Tumors in Veterans: Findings From the VHA National Precision Oncology Program. United States. doi:10.1200/PO.19.00075.
Poonnen MD, Pradeep J., Duffy, Jill E., Hintze, Bradley, Shukla, Maulik, Brettin, Thomas S., Conrad, Neal R., Yoo, Hyunseung, Guertin, Christopher, Looney, Jane A., Vashistha, Vishal, Kelley MD, Michael J., and Spector MD, Neil L. Thu . "Genomic Analysis of Metastatic Solid Tumors in Veterans: Findings From the VHA National Precision Oncology Program". United States. doi:10.1200/PO.19.00075.
@article{osti_1570967,
title = {Genomic Analysis of Metastatic Solid Tumors in Veterans: Findings From the VHA National Precision Oncology Program},
author = {Poonnen MD, Pradeep J. and Duffy, Jill E. and Hintze, Bradley and Shukla, Maulik and Brettin, Thomas S. and Conrad, Neal R. and Yoo, Hyunseung and Guertin, Christopher and Looney, Jane A. and Vashistha, Vishal and Kelley MD, Michael J. and Spector MD, Neil L.},
abstractNote = {The Veterans Health Administration (VHA) is the largest cancer care provider in the United States, with the added challenge of serving more than twice the percentage of patients with cancer in rural areas than the national average. The VHA established the National Precision Oncology Program in 2016 to implement and standardize the practice of precision oncology across the diverse VHA system.METHODSTumor or peripheral blood specimens from veterans with advanced solid tumors who were eligible for treatment were submitted for next-generation sequencing (NGS) at two commercial laboratories. Annotated results were generated by the laboratories and independently using IBM Watson for Genomics. Levels-of-evidence treatment recommendations were based on OncoKB criteria.RESULTSFrom July 2016 to June 2018, 3,698 samples from 72 VHA facilities were submitted for NGS testing, of which 3,182 samples (86%) were successfully sequenced. Most samples came from men with lung, prostate, and colorectal cancers. Thirty-four percent of samples were from patients who lived in a rural area. TP53, ATM, and KRAS were among the most commonly mutated genes. Approximately 70% of samples had at least one actionable mutation, with clinical trials identified as the recommended option in more than 50%. Mutations in genes associated with a neuroendocrine prostate cancer phenotype were expressed at increased frequency among veterans than in the general population. The most frequent therapies prescribed in response to NGS testing were immune checkpoint inhibitors, EGFR kinase inhibitors, and PARP inhibitors.CONCLUSIONClinical implementation of precision oncology is feasible across the VHA health care system, including rural sites. Veterans have unique occupational exposures that might inform the nature of the mutational signatures identified here. Importantly, these results underscore the importance of increasing clinical trial availability to veterans.},
doi = {10.1200/PO.19.00075},
journal = {JCO Precision Oncology},
number = ,
volume = 3,
place = {United States},
year = {2019},
month = {8}
}