Delays in BRAF Test Results Affect Quality of Care, Therapeutic Options in Melanoma

A retrospective cohort study identified barriers to improving BRAF testing turnaround time (TAT) in patients with melanoma at the Princess Margaret Cancer Centre in Toronto, Canada.¹

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.

Investigators reviewed 147 patient charts and determined that 66 patients were eligible for study.When pathology ordered reflex BRAF testing, the median TAT was 12 days (95% CI, 8-15), compared with 20 days (95% CI, 16-23) 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 TAT was 13 days (95% CI, 6-19) compared with 19 days (95% CI, 16-21) if the sample was transferred from another institution (P = .02).

This study analyzed new patients referred to the medical oncology melanoma site at the Princess Margaret Cancer Centre, University Health Network in Toronto, Ontario from January 2019 to August 2019. Patients were to have histologically confirmed cutaneous or mucosal melanoma and to have had BRAF molecular testing performed in 2019. This analysis recorded the dates of the BRAF test request, when the results were completed, and the intervening steps required to obtain this result in 2019.

The time from the first visit and starting treatment was 28 days (95% CI, 21.2-34.7) if the BRAF result was available and 34 days (95% CI, 27.1-40.8) if the BRAF result was not available (P = .097).

The median age of patients was 64 years (range, 24-88), and 64% were male. Patients had disease stage II to IV with 15% having stage II, 50% with stage III, and 35% with stage IV disease. Fifty of the 66 were newly diagnosed. Investigators found 28 patients (43%) were positive for the BRAF V600 E/K mutation as determined by polymerase chain reaction, and 4 (6%) were positive for other BRAF variants as determined by next generation sequencing (NGS) testing. No variants were detected in 16 patients (24%), 10 patients (15%) had NRAS, 4 patients (6%) had NRAS and CDKN2A, 2 patients (3%) had KIT, and 2 patients (3%) had CDK2N2A and/or CDKN2B. Half of the patients (n = 33) had available BRAF test results at their first Princess Margaret Medical Oncology visit.

In the subgroup with stage IV disease, 20 of 23 patients received systemic therapy, and the median time to treatment initiation was 24 days.The median time to treatment initiation was 20 days (95% CI, 9.6 to 30.3) if BRAF results were available vs 31 days (95% CI, 10.8 to 51.1) if BRAF results were not available (P = .03).

In the adjuvant therapy subgroup, 17 of 27 patients were seen by medical oncology after the completion of all surgical procedures. The median time to initiate systemic therapy was 30 days (95% CI, 19.8-40.1) when results were available, which was not significantly affected by the availability of BRAF results.The median time to initiate systemic therapy was 27 days (95% CI, 18.4-35.6; P = .69) when results were unavailable.

This study showed variations in TAT for BRAF test results, which affected the duration of therapeutic intervention. Investigators concluded that transfer time can be streamlined when using pathology reflex testing.Especially in patients with stage IV disease, these delays in TAT affect the timing and type of therapeutic intervention the patient may need.

_REFERENCE

_{Arteaga Ceballos DP, Saeed-Kamil Z, King I, et al. Turnaround times in melanoma BRAF testing and the impact on the initiation of systemic therapy at a single tertiary care cancer center. Published online April 1, 2022. JCO Oncol Pract. 2022;OP2100810. doi:10.1200/OP.21.00810}