Cancer-type-specific gaps between treatment recommendation and implementation following comprehensive genomic profiling: a nationwide real-world study.

Abstract

Background: Comprehensive genomic profiling (CGP) has been reimbursed in Japan since 2019; however, the extent to which treatments recommended by expert panels are subsequently implemented and how this varies across cancer types remain unclear.

Methods: Among 50,974 patients with solid tumors registered in the C-CAT database between June 2019 and April 2023, 44,669 adult patients met the eligibility criteria and were included in the analysis. Patients were grouped into three cohorts: non-small cell lung cancer (NSCLC), colorectal cancer (CRC), and other solid tumors. We evaluated the proportion of patients with at least one drug-based treatment recommended by an expert panel (PoTR) and the proportion who subsequently received an expert-panel-recommended treatment (PoTI). We also conducted exploratory multivariable analyses of factors associated with PoTR and, among patients who received a treatment recommendation, PoTI.

Results: The PoTR was 54.57% for NSCLC, 53.80% for CRC, and 39.92% for other solid tumors. The PoTI was 16.74%, 7.96%, and 7.74%, respectively. A substantial gap between treatment recommendation and implementation was observed across cancer types. Among the Cohort C organ groups, PoTI was higher in the prostate and breast groups and lower in the pancreatic and soft-tissue groups. Exploratory adjusted analyses showed that the associations of age, ECOG performance status, CGP panel, and cohort differed between the PoTR and conditional PoTI models.

Conclusion: This nationwide analysis found substantial variation in treatment recommendation, recorded implementation, and the gap between them across the prespecified cancer cohorts. These descriptive findings may help frame patient counseling and expectations regarding treatment recommendation and subsequent implementation after CGP.