Prognostic impact of genomically matched therapy for solid cancers using real-world data from a provincial hospital in Japan

Background Comprehensive genomic profiling (CGP) has been publicly reimbursed in Japan for five years, yet its impact on survival in real-world provincial settings remains unclear. Methods We retrospectively analyzed 914 patients with solid tumors who underwent tissue- or blood-based CGP at our institute between December 2019 and July 2023. Results The median age of patients was 66 years. Colorectal (18.9%) and pancreatic (16%) cancers were most common. Actionable alterations were detected in 87.5%, and druggable alterations in 58.3% of patients. Genomically matched therapy was administered to 10.9% of patients, who had better survival than those with druggable alterations who did not receive therapy (hazard ratio [HR]: 0.56, 95% confidence interval [CI]:0.42–0.74) or those without actionable alterations (HR: 0.63, 95%CI:0.47–0.83). A progression-free survival ratio > 1.3 was observed in 39.4% of patients. Multivariate analysis confirmed matched therapy was an independent favorable prognostic factor. Despite lower detection and treatment rates with blood-based CGP because of false negatives, survival benefit was preserved. Patients referred from external institutions had delayed CGP testing, but treatment benefit was slightly greater. Survival improvement was not observed in patients undergoing four or more prior regimens. Conclusions: CGP-guided matched therapy may improve survival even in provincial settings. To optimize clinical utility, the appropriate CGP panel must be offered to the appropriate patient at the optimal time.