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Retrospective Study Shows Variations in BRAF Test Results in Turnaround Time Among Patients With Melanoma
In adult patients with melanoma, delays in testing for BRAF mutations affected the type of therapeutic intervention and delayed initiation of treatment, according to a retrospective study that mapped BRAF testing timelines (JCO Oncol Pract. 2022. OP2100810. doi:10.1200/OP.21. 00810).
“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,” wrote Marcus Butler, MD, Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, Canada, and colleagues, adding, “Activating BRAF mutations at amino acid 600 are present in approximately 45% of all melanomas, resulting in constitutive BRAF protein kinase activity.”
The study included 66 patients with melanoma and aimed to identify obstacles to timely BRAF test result reporting and its impact on therapy initiation. Of the 66 included patients, 47 received systemic therapy. The researchers began the study by mapping the dates of the BRAF test requests and results and the intervening steps needed to get each result.
Along with mapping BRAF testing timelines, the researchers recorded the dates of the first visit to medical oncology and the date therapy was initiated. These dates were correlated with the availability of BRAF test results to measure the effect on initiation of therapy.
Data analysis revealed that the median time between a request for BRAF testing and the availability of the test result was 12 days (95% confidence interval [CI], 8 d to 15 d) when the test was ordered by a pathologist but was 20 days (95% CI, 16 d to 23 d) if the test was requested by another specialist (P<0.001).
In addition, when the BRAF test and biopsy were done at the same institution, median turnaround time for a test result was 13 days (95% CI, 6 d to 19 d), but when the sample was transferred from another institution for testing, median turnaround time was 19 days (95% CI, 16 d to 21 d; P=0.02).
The median time between the first medical oncology visit and treatment initiation was 28 days (95% CI, 21 d to 25 d) if the BRAF test result was available and 34 days (95% CI, 27 d to 41 d) if it was not.
In the subgroup of 20 patients with metastatic disease, treatment initiation took 20 days (95% CI, 10 d to 30 d) if the BRAF test result was available during the first medical oncology visit. However, treatment initiation was delayed by 11 days to 31 days (95% CI, 11 d to 51 d) if the BRAF test result was not available at that visit (P=0.03).
“One factor affecting this timeline is the transfer time, which can be streamlined by pathology reflex testing,” wrote Dr Butler and team. “Delays in [turnaround time] affect the timing and type of therapeutic intervention, especially in patients with stage IV disease,” they concluded.
