Leading Squamous Cell Carcinoma Practitioners Publish Consensus Guidelines Integrating DecisionDx-SCC into a Clinical Workflow to Improve Decision-Making Regarding the Use of Adjuvant Radiation Therapy - Seite 2

“As a panel, we agreed that the process used today to route SCC patients for ART can be improved, and DecisionDx-SCC can be a determining factor in the next step for management of high-risk SCC,” added Gaurav Singh, M.D., MPH, consensus panel member, and board-certified dermatologist, Mohs surgeon and assistant professor of dermatology in Wisconsin. “The test provides independent risk-stratification that can augment existing risk prediction systems, including AJCC8 and Brigham and Women’s Hospital (BWH) staging, to inform these important decisions with greater accuracy and ensure ART is brought to patients with the highest risk of disease progression who are most likely to benefit from treatment. DecisionDx-SCC can also help validate the decision to avoid radiation in seemingly high-risk tumors that are in fact low risk based on genetic profile.”

Specific consensus recommendations and statements outlined in the article include the following:

• A DecisionDx-SCC Class 2A or 2B result, indicating a higher or highest risk of metastasis, in each AJCC8 tumor stage serves as a high- or very high-risk feature for consideration in recommending ART.
  • The increased metastatic risk conferred by a Class 2A or 2B result in multivariate analysis (hazard ratio=2.3, p=0.013; and hazard ratio=6.9, p<0.001, respectively) is similar or higher than that conferred by other high-risk clinicopathologic features, including PNI and poor differentiation.
• Patients at the highest risk of metastasis, as indicated by a DecisionDx-SCC Class 2B test result, should be referred to radiation oncology with a recommendation for a multidisciplinary tumor board discussion.
• In nuanced discussions where the risks associated with ART may outweigh the benefits, the additional information provided by the DecisionDx-SCC test can assist in personalized decision-making.
• The DecisionDx-SCC test can help radiation oncologists determine a more precise risk-benefit ratio for elective nodal radiation.
  • The panel recommended stronger consideration of elective nodal radiation for a DecisionDx-SCC Class 2B tumor, given the dramatically increased risk of nodal metastasis.

Overall, the panel agreed the DecisionDx-SCC test provides independent risk stratification that, when combined with traditional staging and management guidelines, enhances the clinical picture, allowing clinicians to more accurately identify SCC patients who are most likely to benefit from ART, as well as lower-risk patients who would benefit less from treatment. In a validation study of the DecisionDx-SCC test by Wysong et al., metastatic risk prediction of AJCC8 and BWH staging systems was significantly improved when DecisionDx-SCC test results were included.³ As supported by the consensus article, the objective, independent risk stratification provided by the test can improve precision in multidisciplinary treatment recommendations, such as the use of ART, which could save the U.S. healthcare system hundreds of millions of dollars through more appropriate use of the treatment.⁴