40-Gene expression profile tests can risk-stratify patients with cutaneous scc in real-world setting

Farberg, A., Siegel, J., Rackely , B., Fitzgerald, A., Kurley, S., & Cook, R. (2022). Appropriate utilization of the prognostic 40-gene expression profile (40-GEP) test for cutaneous squamous cell carcinoma (cSCC) demonstrated by clinical reports and physician evaluation of real-world cases. SKIN The Journal of Cutaneous Medicine, 6(2), s21. https://doi.org/10.25251/skin.6.supp.21

Clinical Pearls:

• This study was a real-world cross-sectional analysis of how practicing dermatologists are implementing a 40-gene expression profile (40-GEP) test in the care of patients with cutaneous squamous cell carcinoma (cSCC).

• The authors found that when 34 dermatologists were presented with 6 real-world patient cases, their intervention (e.g., pursuing nodal assessment or adjuvant radiation therapy, follow-up frequency) intensity increased or decreased proportional to modified risk assessment provided with the 40-GEP.

• 2468 biopsy samples from patients with cSCC received over a 1 year period and were also assessed and found that 75.3% had ≥2 high-risk factors.

Discussion:

This was a real-world cross-sectional analysis of how practicing dermatologists are implementing a 40-gene expression profile (40-GEP) test in the care of patients with cutaneous squamous cell carcinoma (cSCC). 34 dermatologists and non-physician dermatologist clinicians were provided 6 real-world cases representative of those submitted for 40-GEP test assessment. Participants were queried regarding treatment recommendations of these 6 cases without (pre-test) and with (post-test) a 40-GEP score.

Pre-test participants had very uniform approach to therapy based on patient and tumor characteristics. Post-test recommendations changed significantly based on 40-GEP test results with increased overall management intensity (with regards to nodal assessment, follow-up frequency, and adjuvant radiation therapy) for patients revealed to have had a Class 2B (highest risk) result even if pre-test they clinicopathologically were rated as being “low-risk”.

Additionally, 2468 biopsy samples received between August 31,2020 – August 31, 2021 with successful test results were assessed in conjunction with patient (e.g., immunosuppression) or tumor (location, size, clinical borders, growth rate, >2mm invasion, histologic subtype, lymphovasculature (LVI), perineural (PNI) or subcutaneous invasion) characteristics. Analysis found 75.3% of samples had ≥2 high-risk factors, indicating the test was being used within the appropriate population (i.e., classified as being high or very high risk by National Comprehensive Cancer Network (NCCN)).

This cross-sectional study demonstrates appropriate use of the 40-GEP among at-risk patient population but also within individualized clinical algorithms and that the additional information provided by the 40-GEP test can provide nuance to patient care.