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Implementation of precision oncology in the Veterans Health Administration (VHA).

Publication ,  Journal Article
Kelley, MJ; Duffy, J; Hintze, BJ; Williams, CD; Spector, NL
Published in: Journal of Clinical Oncology
May 20, 2017

6507 Background: VHA is the US’s largest integrated healthcare system providing care to over 6 million Veterans (~40% in rural areas). Precision Oncology offers the promise of effective, low-toxicity targeted therapies tailored to individual tumor genomics but is unequally available to patients in the US. As part of the Cancer Moonshot, VHA is implementing a system-wide Precision Oncology Program (POP) including patients in rural areas, where specialty oncology care has historically had limited availability. Methods: Patients tested with multigene NGS tumor sequencing through 1 of 2 contracted vendors were identified from POP records and cancer characteristics were extracted from POP and medical records. Drug use data was obtained from the VA Corporate Data Warehouse. NGS testing results and annotations were extracted from POP records. Results: A total of 978 tumor samples were sent for NGS testing since program inception in 2015. The most common diagnoses are lung (464: adeno 314, squamous 107), GI (87), LN (75), liver (56), H&N (52), and prostate (43). The rate of sample test requests increased rapidly after national implementation in July 2016 (mean 23 samples/month prior to implementation to mean 126 samples/month 3 months later) as did the number of participating facilities (mean 8/month to 27/month). Sequencing success rate increased from 68% to 71% over the same interval while mean turn around time remained similar at 19.7 and 19.1 d, respectively. NGS results are available for a cohort of 344 patients including: lung 200 (adeno 138, squamous 51), skin 28, LN 20, liver 19, GI 16. 979 variants were found including TP53 278, KRAS 106, STK11, APC 38, PIK3CA 38, and CDKN2A 37. 228 patients had actionable results (on-label drug 24, off-label drug 165, clinical trial 213). To date, 8 patients received a recommended drug outside a clinical trial between 11 and 288 d after testing (median 82 d); 4 additional patients had received an NGS-recommended drug prior to testing. Conclusions: Implementation of tumor NGS testing as part of Precision Oncology Program in a US distributed healthcare system is feasible. Further program implementation and provision of appropriate targeted drugs both on and off study will be necessary to impact patient outcomes.

Duke Scholars

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

May 20, 2017

Volume

35

Issue

15_suppl

Start / End Page

6507 / 6507

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kelley, M. J., Duffy, J., Hintze, B. J., Williams, C. D., & Spector, N. L. (2017). Implementation of precision oncology in the Veterans Health Administration (VHA). Journal of Clinical Oncology, 35(15_suppl), 6507–6507. https://doi.org/10.1200/jco.2017.35.15_suppl.6507
Kelley, Michael J., Jill Duffy, Bradley J. Hintze, Christina D. Williams, and Neil L. Spector. “Implementation of precision oncology in the Veterans Health Administration (VHA).Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 6507–6507. https://doi.org/10.1200/jco.2017.35.15_suppl.6507.
Kelley MJ, Duffy J, Hintze BJ, Williams CD, Spector NL. Implementation of precision oncology in the Veterans Health Administration (VHA). Journal of Clinical Oncology. 2017 May 20;35(15_suppl):6507–6507.
Kelley, Michael J., et al. “Implementation of precision oncology in the Veterans Health Administration (VHA).Journal of Clinical Oncology, vol. 35, no. 15_suppl, American Society of Clinical Oncology (ASCO), May 2017, pp. 6507–6507. Crossref, doi:10.1200/jco.2017.35.15_suppl.6507.
Kelley MJ, Duffy J, Hintze BJ, Williams CD, Spector NL. Implementation of precision oncology in the Veterans Health Administration (VHA). Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2017 May 20;35(15_suppl):6507–6507.

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

May 20, 2017

Volume

35

Issue

15_suppl

Start / End Page

6507 / 6507

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences