Comprehensive genome profiling for treatment decisions in patiënten met metastatic tumors: real-world evidence meta-a...

BACKGROUND: Although precision oncology has rapidly been developed in recent years, its real-world impact and challenges in health care implementation remain underexplored. Through a meta-analysis of real-world evidence (RWE), we aimed at investigating the applicability and clinical impact of comprehensive genome profiling (CGP) in cancer patients with metastatic solid tumors. METHODS: We systematically searched Medline, Embase, and Web of Science for RWE studies on CGP and matched therapies in metastatic solid tumors (publication period: 2012-2023). Pooled proportions of actionable genomic alterations, patients treated with matched targeted therapies, treatment, and survival outcomes were calculated. Data from Swedish cancer registries were used as a case study for nationwide CGP implementation. RESULTS: Out of the 7218 identified studies, 144 were included in our analysis; 59.8% of CGP-tested patients had actionable genomic alterations, with 15.6% (95% CI = 13.4% to 18.2%) of them having received targeted therapy. Objective response was seen in 23.9% (95% CI = 20.8% to 27.3%). Overall, CGP-guided treatment was correlated with prolonged progression-free survival (pooled hazard ratio [HR] = 0.63; 95% CI = 0.56 to 0.70; 18 studies) and overall survival (pooled HR = 0.60; 95% CI = 0.51 to 0.70; 21 studies) when compared to conventional treatment. Meta-regression time projections analyses showed that these rates will steadily increase by 2030. CONCLUSIONS: Pooled analyses of RWE studies indicate that approximately one-fourth of the patients receiving CGP-matched treatment have an objective response. By utilizing meta-regression projections, our nationwide cancer registry case study offers insights into the potential of precision oncology for patients with metastatic cancer and to inform future health care strategies.