Conflicted Confidence: Academic Oncologists' Views on Multiplex Pharmacogenomic Testing

摘要: Multiplex somatic genomic tests simultaneously evaluate multiple pharmacogenomic loci in the tumor genome to identify variants that may drive growth, invasion, and/or metastatic spread of cancer and serve as targets for currently available or experimental therapies. In recent years, a growing number multiplex panels with capacity examine tens hundreds genetic have become oncology care providers through research studies commercial sources, large part result improved time cost efficiencies afforded by testing using next-generation sequencing technologies. A minority are sequenced harbor clinically relevant which targeted therapies approved US Food Drug Administration particular indication (eg, anaplastic lymphoma kinase [ALK] inhibitors patients adenocarcinoma lung found an ALK mutation), whereas remaining when detected best be considered at this time. This latter group includes genes containing are, first, potentially actionable, including those therapy exists but is unproven unapproved, current indication, second, other uncertain significance, thus neither nor actionable Although widely endorsed, clinical utility routine remains unclear present, both because insurance coverage concerns high potential generate information. With abundance new powerful entering arena, oncologist has critical responsibility determine how integrate into practice. Indeed, National Genome Research Institute established Division Genomics Society 2012, focus attention resources on societal impact advances. body literature begun from viewpoint health professionals faced daunting task. Studies Fargher et al and, more recently, Haga queried views pharmacists, primary providers, counselors, others regarding testing, although generally eliciting positive attitudes toward value care, identified highly diverse perceived roles delivering genomics-based medical equally (and often negative) assessments preparedness do so. However, previous not specifically examined active, academic oncologists’ perceptions ways will affect patients. article accompanying editorial, Gray present results survey practicing oncologists Dana-Farber Cancer (DFCI) was conducted before roll-out researchbased, center-wide test (OncoMap). Using mixed-methods techniques, investigators offer snapshot physicians leading Institute–sponsored comprehensive center perceive information it generate, their intentions its use, what degree these individuals express confidence abilities incorporate patient care. The report findings timely community alike, particularly impressive robust response rate (61%) achieved nonincentivized, Web-based survey. Included 160-participant sample were (43%), surgical (29%), radiation (19%), who whole reported broad range professional effort devoted practice, research, administrative teaching duties, well diversity interests ranging trials basic science. At baseline, exposure modest. Surgical low use practices—36% 71%, respectively, had never ordered such KRAS inform anti–epidermal growth factor receptor colorectal treatment). addition describing participant interest respect OncoMap test, hypothesized being oncologist, baseline third factor, termed confidence, would associated greater stronger disclose Genomic measured three-item scale devised study participants’ knowledge about genomics, ability explain concepts patients, guide treatment. Finally, additionally likely JOURNAL OF CLINICAL ONCOLOGY E D I T O R L VOLUME 32 NUMBER 13 MAY 1 2014