E-Poster Presentation 34th Lorne Cancer Conference 2022

SUPER-NEXT: employing comprehensive clinical genomics for cancer of unknown primary. (#347)

Richard J Rebello 1 , Clare Fedele 1 , Tharani Sivakumaran 1 2 , Samantha Webb 2 , Aidan Flynn 1 , Atara Posner 1 , Owen Prall 2 , Catherine Mitchell 2 , Nadia Traficante 2 , Camilla Mitchell 1 , Joseph Vissers 1 , Huiling Xu 2 , Shiva Balachander 2 , Krista Fisher 2 , Hui-Li Wong 2 , Kym Sheehan 3 , Chris Karapetis 4 , Ian Collins 5 , Mark Warren 6 , Bo Gao 7 , Madhu Singh 8 , Christopher Steer 9 , Desmond Yip 10 , Pei Ding 11 , Nicholas Wilcken 7 , Stephen Quinn 12 , Narayan Karanth 13 , Anna DeFazio 14 , Anna Kuchel 15 , Rachel Wong 16 , Mark Shackleton 17 , Zee Wan Wong 18 , Louise Nott 19 , Shamsudeen Padinharakam 20 , Sarah Jane Dawson 1 2 , Rodney Hicks 2 , David Bowtell 2 , Andrew Fellowes 2 , Stephen Fox 2 , Louisa Gordon 21 , Oliver Hofmann 1 , Sean Grimmond 1 , Penny Schofield 22 , Linda Mileshkin 2 , Richard Tothill 1
  1. University of Melbourne Centre for Cancer Research, Melbourne, Victoria, Australia
  2. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  3. University of Sydney, Sydney, New South Wales, Australia
  4. Flinders Cancer Centre, Flinders University, Flinders Cancer Centre, Adelaide, South Australia, Australia
  5. South West Healthcare, Warrnambool, Victoria, Australia
  6. Bendigo Cancer Centre, Bendigo Health, Bendigo, Victoria, Australia
  7. Westmead Private Hospital, Westmead, New South Wales, Australia
  8. Barwon Health Cancer Services, Barwon, Victoria, Australia
  9. Border Medical Oncology, Albury Wodonga Regional Cancer Centre, New South Wales, Australia
  10. Department of Medical Oncology, Canberra Hospital, Canberra, Victoria, Australia
  11. Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, Australia
  12. Swinburne University of Technology, Department of Health Science and Biostatistics, Melbourne, Victoria, Australia
  13. Medical Oncology Department, Alan Walker Cancer Centre, Royal Darwin Hospital, ., Darwin, Australia
  14. Centre for Cancer Research, University of Sydney, Sydney, New South Wales, Australia
  15. Department of Medical Oncology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  16. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
  17. Department of Medical Oncology, Alfred Health, Melbourne; Central Clinical School, Monash University, Melbourne, VIC, Melbourne, Victoria, Australia
  18. Oncology Unit, Peninsula Health, Peninsula, Victoria, Australia
  19. Royal Hobart Hospital, Hobart, Tasmania, Australia
  20. Launceston General Hospital, Launceston, Victoria, Australia
  21. QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Queensland, Australia
  22. Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia

Cancer of unknown primary (CUP) is the 6th most common cause of cancer-related death in Australia. CUP has a dismal prognosis with one and 5-year survival rates of 25% and 14%, respectively. Since cancer medicine is largely based on anatomical location, CUP significantly challenges the established care paradigms. CUP patients are disadvantaged in the access of molecularly targeted therapies through clinical trials or the pharmaceutical benefit scheme (PBS) as known tissue of origin is often a requirement. A strong rationale therefore exists to develop better diagnostic methods for CUP to help resolve the primary origin of a patient’s tumour. In addition, employing precision medicine by identifying mutations that guide targeted treatment offers an alternative to conventional site-directed chemotherapies. Through the “Solving Unknown Primary cancER” (SUPER) study, we have shown that panel-based testing can help resolve a diagnosis in many CUP patients as well as aid in directing targeted treatments based on molecular profiling of the tumour. SUPER-NEXT now seeks to test clinical whole genome and transcriptome (WGTS) sequencing to measure the increased sensitivity over panel-based approaches. Furthermore, the use of “liquid biopsies” to harvest circulating tumour DNA in patient blood, will be tested alongside, and could potentially enable non-invasive and more rapid genomic testing. SUPER-NEXT is a collaborative study involving the Peter MacCallum Cancer Centre, the University of Melbourne, Swinburne University and QIMR-Berghofer recruiting patients from 16 participating clinical sites across six Australian states and territories. The potential benefits of the different tests will be measured through surveying pathologists and medical oncologists before and after the return of genomic test results. Patient reported outcomes are captured at baseline and at 3-months post testing and clinical follow-up at 6, 12 and 18 months. Health system costs and patient health benefits (via changes in patient management) will also be assessed.