Analysis of Clinical Sequencing Reports from the MMRF CoMMpass Study
Multiple myeloma (MM) is a cancer of plasma cells that generally localizes to the bone marrow. The Multiple Myeloma Research Foundation CoMMpass Study is an observational clinical study of 1143 MM patients from clinical sites in the United States, Canada, Spain, and Italy. In the CoMMpass study, tumor samples are sequenced for research at diagnosis and at each progression event and clinical parameters, including treatment regimen, are collected every three months for a minimum of eight years. Beginning in 2016, tumor samples collected at progression were also sequenced at TGen’s clinical laboratory, Ashion. The clinical sequencing assay identifies the patient’s reportable genomic alterations and Ashion curates a clinical report which is sent to the patient’s physician outlining alteration-specific treatment options and potential clinical trials in which the patient can enroll. The goal of this study is to summarize the results of the clinical sequencing reports generated by Ashion as part of the CoMMpass study and determine whether any patients received the treatment(s) suggested by the clinical report. To date, 61 clinical sequencing reports were available for analysis from 56 unique patients at 19 different clinical sites. Analysis of the results of the clinical sequencing reports revealed that, on average, patients have two actionable genomic alterations associated with either an FDA-approved treatment for MM or another cancer, or an ongoing clinical trial. However, 13 of the patients had no actionable alterations. It was found that missense mutations account for half of all actionable alterations, and mutations in KRAS, NRAS, and TP53 make up 45% of the actionable gene alterations reported. To date, only one patient received the treatment suggested in their clinical report and, interestingly, none of the three patients with FDA-approved MM-specific drug recommendations received the suggested treatment after the report was issued. Overall, this analysis suggests that data from the clinical reports generated on the CoMMpass study are generally underused by physicians when making treatment decisions. Improving patient and physician awareness of report availability, improving the clinical report format, or educating physicians on how to read and interpret the clinical reports may increase their use by physicians when making treatment decisions, which may have significant impact on treatment outcomes in relapsed MM.