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Recommendation against genetic expression profile testing for melanoma Tx guidance

A consensus statement from an international group of melanoma researchers recommends against the prognostic use of genetic expression profile (GEP) testing to guide clinical management of patients with melanoma.

In the statement, published in JAMA Dermatology (July 29, 2020, online ahead of print) and written by members of the Melanoma Prevention Working Group (MPWG), the authors note that while GEP testing is seeing increasing use as a tool for cutaneous melanoma prognosis, this is despite GEP testing not having been endorsed as a standard of care.

To develop guidelines on integrating GEP into management of patients with cutaneous melanoma, the MPWG members, as well as other international melanoma specialists, participated in two online surveys, then convened a summit meeting where they reviewed data and meeting abstracts published from 2015 to 2019.

They found that the published studies of GEP testing had not evaluated their results in the context of all relevant clinicopathologic factors, or as predictors of regional nodal metastasis. As well, most of the reporting on the performance of GEP tests had been done for small groups of patients. Also, this data was either reported in aggregate, or for groups of patients at specific tumour stages, so there was no way to compare survival outcomes or stage-specific performance.

The statement also notes that there are significant challenges to performing clinical trials incorporating GEP testing with sentinel lymph node biopsy and adjuvant therapy.

As a result of these findings, the MPWG members write that they favour conducting retrospective studies that evaluate multiple GEP testing platforms on archived samples before prospective studies are undertaken. They also recommend against routine use of GEP testing to direct patient management until prospective studies support their clinical utility.

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