Title : Gene expression profiling in melanoma- Finding its niche
Abstract:
Aim: There are several issues with current methods used to aid prognostication and management in cutaneous melanoma. Gene expression profiling is a novel prognostication method that has been developed to be the future for prognostication in cutaneous melanoma patients. They have considerable promise, but also current limitations that stop them from fully being implemented into clinical guidelines. This literature review aims to find out why these GEP’s for cutaneous melanoma have not found the same utility as GEP’s used in other cancers.
Method: I conducted a literature search using Medline, Embase and pubmed as well as looking at the GEP’s manufacturers website to analyse why certain GEP’s are being implemented into clinical guidelines whereas others aren’t.
Result: The reason for the lack of national implementation shown to melanoma GEP’s range from technical issues with studies advocating for these GEP’s, to no study ever proving the clinical utility in using these new models. However, the fault could also lie with researchers not yet highlighting its USP, of having a high negative predictive value. This would mean, these GEP`s can be used as a rule out test to identify patients who don’t have a high risk of developing nodal metastasis and consequently a worse prognosis and so can forgo a sentinel lymph node biopsy and the complications associated with them.
Conclusion: GEP’S should focus on being used specifically as a rule out test if they want to be incorporated into clinical guidelines.
Audience Take Away Notes:
- Audience will learn about the ongoing issues have been identified with current methods used to aid prognostication and management in cutaneous melanoma. These include issues with: The staging criteria by The American Joint Committee on Cancer, the management guidelines dictated by the National Comprehensive cancer Network and the costs associated with performing unnecessary sentinel lymph node biopsies
- They will also learn about Gene expression profiling that has been developed to be the future for prognostication in patients with cutaneous melanoma, and I will use the most popular ones ( the 31-GEP and CP-GEP) as a case study telling them about their limitations that stop them being implemented into clinical guidelines and why they shouldn’t be solely used
- I will explain the reasons for these GEP’s not having the same utility as GEP’s used in other cancers. This includes a range of factors from technical issues with studies advocating for these GEP’s, to no study ever proving the clinical utility in using these new models. However, the fault could also lie with researchers not yet highlighting its USP, of having a high negative predictive value
- I would explain what the GEP’s can be used for such as a rule out test to identify patients who don’t have a high risk of developing nodal metastasis and consequently a worse prognosis and so can forgo a sentinel lymph node biopsy and the complications associated with them
- Lastly I would list several key ingredients that have been identified to what makes a successful GEP, such as developing a GEP with a specific purpose in mind, which the audience can take back with them and implement to their own practice
