Sharett Institute of Oncology, Hadassah Medical Organization, Jerusalem, Israel
Background: Predictive bio-markers for personalized treatment of neoplasms are suggested to be a major advancement in oncology. Such predictive tests are increasingly utilized in clinical practice albeit based on level II evidence. "Target Now" (®,TN) employs immuno-staining and RNA expression methods on tumor samples to identify potentially beneficial and ineffective drugs. The aim of the current study was to explore retrospectively the predictive value of TN in patients with colo-rectal and gastric carcinomas. Methods: Patients treated at the Sharett Institute of Oncology for whom TN testing was performed, with colo-rectal or gastric carcinoma, were included in the study. Systemic treatments given in the metastatic setting, before or after TN testing, were identified for which at least one agent had a prediction in the TN test. Protocols were classified as having clinical benefit (CB; i.e. stable disease or any response) or progressive disease and this was compared with the TN prediction. Importantly, protocols were analyzed irrespective of time given (i.e. prior to- or following TN testing). Results: Nineteen patients met inclusion criteria, 12 colo-rectal and 7 gastric carcinomas; 12 males and 7 females, mean age at diagnosis 49±14 years, mean time from diagnosis to TN testing 3.87±4.74 years. There were 26 evaluable treatment protocols; 18 had a CB of which 15 were predicted to have a CB while 3 were predicted to have a lack of CB. Of 8 protocols that had no CB, 7 were predicted to have a CB while one was predicted to have a lack of CB. A χ2 test performed was non-significant (P=0.78). An exploratory analysis yielded a positive predictive value of 68% and a sensitivity of 83% for the TN test. Conclusion: Our results suggest the TN test has a predictive value in choice of systemic therapy for metastatic colo-rectal and gastric neoplasms. Larger multi-center studies with sufficient statistical power should be performed to validate the current findings.
