Turnaround Times in Melanoma BRAF Testing and the Impact on the Initiation of Systemic Therapy at a Single Tertiary Care Cancer Center

Author:

Arteaga Diana P.12ORCID,Saeed-Kamil Zaid34,King Ian345,Stockley Tracy345ORCID,Liu Diane6,Muniz Thiago P.12ORCID,Saibil Samuel D.126,Hogg David12,Spreafico Anna126,Butler Marcus O.126ORCID

Affiliation:

1. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

2. Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, Canada

3. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada

4. Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

5. Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Canada

6. Tumor Immunotherapy Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

Abstract

PURPOSE: The identification of BRAF mutations in melanoma enables targeted therapy and improves patient outcomes. Barriers to BRAF molecular testing affect the quality of care and therapeutic options. METHODS: This retrospective study mapped BRAF testing timelines in adult patients with melanoma at the Princess Margaret Cancer Centre to identify obstacles to timely BRAF reporting and its impact on the initiation of therapy. RESULTS: Sixty-six cases were included. The median time between BRAF request and result was 12 days (95% CI, 8 to 15) when the BRAF test was ordered by pathology, compared with 20 days (95% CI, 16 to 23) if the test was requested by another specialist ( P < .001). When the BRAF test and biopsy were performed within the same institution, the BRAF median turnaround time (TAT) was 13 days (95% CI, 6 to 19) compared with 19 days (95% CI, 16 to 21) if the sample was transferred from another institution ( P = .02). Forty-seven patients received systemic therapy, and 20 had metastatic disease. In the metastatic subgroup, if the BRAF result was available at the first medical oncology visit, the initiation of treatment was 20 days (95% CI, 9.6 to 30.3), but was delayed to 31 days (95% CI, 10.8 to 51.1) if the BRAF result was not available ( P = .03). CONCLUSION: This study showed variations in BRAF test results in TAT. One factor affecting this timeline is the transfer time, which can be streamlined by pathology reflex testing. Delays in TAT affect the timing and type of therapeutic intervention, especially in patients with stage IV disease.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Oncology (nursing),Health Policy,Oncology

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