The following is a summary of “31-GEP (DecisionDx): a review of clinical utility and performance in a Mayo Clinic cohort,” published in the August 2024 issue of Dermatology by Pazhava et al.
Cutaneous melanoma (CM) is a type of skin cancer that can spread to other parts of the body. At the same time, Gene Expression Profile (GEP) testing, specifically the 31-GEP test (DecisionDx-Melanoma), has become more common for determining the risk level in patients with CM.
Researchers conducted a retrospective study to assess how practical the 31-GEP test was in real-world clinical practice and how well it predicted outcomes.
They searched electronic health records to identify patients with CM who had undergone 31-GEP testing (August 2014 and August 2022). The study examined how 31-GEP test results influenced clinical decisions regarding sentinel lymph node biopsy (SLNB), referrals to medical oncology, and post-diagnosis monitoring. Kaplan–Meier curves and Cox proportional hazard models were used to determine how well the test predicted outcomes, specifically relapse-free survival (RFS) and melanoma-specific survival (MSS).
The results showed 65 patients with CM; dermatologists ordered over 80% of the 31 GEP tests. In 81.5% of cases, the 31-GEP test results did not change the standard clinical management. Decisions about SLNB were not affected in 92% of patients with 31-GEP results before SLNB. Among patients with stage I-IIA melanoma, 25% of those with high-risk 31-GEP results were referred to a medical oncologist. Unexpectedly, the rate of nodal metastasis was higher in patients with low-risk 31-GEP results compared to those with high-risk results. Survival analysis revealed that the RFS and MSS curves overlapped between different 31-GEP classes, indicating that the test had limited value in predicting patient outcomes.
They concluded that the 31-GEP test had a limited influence on clinical management decisions and showed limited predictive value.
Source: onlinelibrary.wiley.com/doi/10.1111/ijd.17440
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