GEP test scores high in predicting probability of cancer spreading

A gene expression profile (GEP) test recently found to be effective for cutaneous melanoma has now been found to be capable of improving the prognostic accuracy of sentinel lymph node biopsy (SLNB) in identifying patients at high risk of their cancer spreading.

According to a study published in the March issue of the Journal of the American Academy of Dermatology, the GEP test was able to identify as high-risk a significant number of patients whose sentinel lymph-node biopsy results indicated no increased risk, but who subsequently developed metastatic disease.

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In a multicenter cohort of 217 patients, both the SLNB and the GEP test, DecisionDx-Melanoma, were found to be significant predictors of metastatic risk. The GEP test identified approximately 80% of patients at risk for disease progression. Combining the two prognostic tools showed that patients predicted to be high-risk based on the GEP test alone had similar rates of disease progression whether they were SLNB-positive or SLNB-negative. Further, patients who were SLNB-negative and who were also predicted to be low-risk using the GEP test had lower rates of disease progression than the SLNB-negative group as a whole.

“The majority of patients who are at risk of metastasis and death from melanoma are sentinel lymph-node negative,” study author Pedram Gerami, M.D. tells Dermatology Times. Dr. Gerami is director of melanoma research at Northwestern University’s Skin Cancer Institute. “We currently don’t offer the majority of these patients baseline imaging and other treatment plans that an SLNB-positive patient receives-primarily because there is no consistent way to determine who is at high risk of disease progression. This GEP test is able to identify approximately 80% of those at high risk, and at a specificity that is similar to SLNB-positive status alone.”

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Dr. Gerami adds that “this suggests we can now implement appropriate management plans for these high-risk patients, including active surveillance, so patients can be treated for metastatic disease upon initial manifestation. In the near future, we expect adjuvant clinical trials to proactively treat patients at high risk.”

DecisionDx-Melanoma was developed by Castle Biosciences, Friendswood, Texas. 

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