Assessing Oncologists' Attitudes Concerning Comprehensive Genomic Profiling in Stage IV Lung Adenocarcinoma in Brazil

Aline F Fares; Pedro H Martinez; Pedro H Farina; Isaac Bicalho de Souza; Daniel V Araújo; Narayana S Paiva; Ligia F Orlando; Tatiana Elias Colombo; Eldsamira Mascarenhas; Ana Caroline Z Gelatti; Clarissa Baldotto; Mauro Zukin; Luiz Henrique Araujo; Clarissa Mathias; Gustavo Werutsky; Gilberto de Castro Jr; Vladmir C Cordeiro de Lima

doi:10.1016/j.jtocrr.2022.100402

Assessing Oncologists' Attitudes Concerning Comprehensive Genomic Profiling in Stage IV Lung Adenocarcinoma in Brazil

JTO Clin Res Rep. 2022 Aug 30;3(10):100402. doi: 10.1016/j.jtocrr.2022.100402. eCollection 2022 Oct.

Authors

Aline F Fares^{1

2}, Pedro H Martinez¹, Pedro H Farina¹, Isaac Bicalho de Souza¹, Daniel V Araújo¹, Narayana S Paiva¹, Ligia F Orlando¹, Tatiana Elias Colombo¹, Eldsamira Mascarenhas^{2

3}, Ana Caroline Z Gelatti^{2

4}, Clarissa Baldotto^{2

5}, Mauro Zukin^{2

5}, Luiz Henrique Araujo^{2

6

7}, Clarissa Mathias^{2

8}, Gustavo Werutsky^{2

9}, Gilberto de Castro Jr^{2

10}, Vladmir C Cordeiro de Lima^{2

11}

Affiliations

¹ Department of Medical Oncology, Hospital de Base de São José do Rio Preto and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil.
² Brazilian Group of Thoracic Oncology - GBOT, Salvador, Brazil.
³ Rede D'Or Oncologia Bahia, Salvador, Brazil.
⁴ Oncoclínicas Rio Grande do Sul, Porto Alegre, Brazil.
⁵ Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil.
⁶ DASA Oncologia e Genômica, Rio de janeiro, Brazil.
⁷ Cancer National Institute (INCA), Rio de Janeiro, Brazil.
⁸ Oncoclínicas Bahia, Salvador, Brazil.
⁹ Latin American Clinical Oncology Group, Porto Alegre, Brazil.
¹⁰ Department of Medical Oncology, Institute of Cancer of São Paulo- ICESP, Faculty of Medicine of the Universidade de São Paulo, SP, Brazil.
¹¹ AC Camargo Cancer Center, São Paulo, Brazil.

Abstract

Introduction: Advances in comprehensive genomic profiling (CGP) of lung adenocarcinomas (LUADs) led to personalized treatment for patients. This study evaluated medical oncologists' attitudes toward CGP in a scenario where sponsored funding for CGP was available.

Methods: We designed an online survey assessing CGP use and treating physicians' confidence, composed of three self-confidence domains, which are as follows: confidence in interpreting CGP results, confidence in treating oncogenic-driven LUAD, and confidence in managing tyrosine kinase inhibitor adverse events. The survey was distributed to medical oncologists who treat lung cancer in Brazil. Comparisons between groups were performed using the chi-square or Fisher's exact test. Univariable and multivariable (adjusted OR) analyses were performed.

Results: Among 104 respondents who treat patients with lung cancer, 55% were from the Southeast region, 28% had high lung cancer clinical load, and 33% had in-house molecular testing. More than half (51%) of the participants request CGP systematically to stage IV LUAD. As for provider confidence, 67% stated being confident in all three domains: 76% confident in interpreting CGP, 84% confident in treating oncogenic-driven LUAD, and 81% in managing tyrosine kinase inhibitor adverse events. Providers' confidence was associated with systematically requesting CGP to stage IV LUAD (p = 0.013). After controlling for the variables of interest, systematic requesting CGP for stage IV LUAD revealed a significant association with the provider's confidence (adjusted OR = 0.35, p = 0.028, 95% CI: 0.14-0.84). The major challenge for properly requesting CGP was the long turnaround time and the fear of treatment delays.

Conclusions: Even though CGP for stage IV LUAD in Brazil is fully sponsored, only half of the oncologists in our survey systematically request it.. Requesting CGP was associated with providers' confidence. Improving access and promoting providers' awareness of CGP utility is necessary to increase CGP use and better inform treatment decisions.

Keywords: Adenocarcinoma; Comprehensive genomic testing; Lung; Oncogenic-driven.