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New publication: In the Journal of Clinical and Aesthetic Dermatology (JCAD) highlights multidisciplinary consensus guidelines that recommend combining traditional staging with DecisionDx-SCC (40-GEP) to improve treatment recommendations, including the use of ART.
Read the article here.
![JCAD Image JCAD Image](https://info.castlebiosciences.com/hs-fs/hubfs/JCAD%20Image.jpg?width=210&height=281&name=JCAD%20Image.jpg)
Integrating DecisionDx-SCC 40-GEP testing improves precision in multidisciplinary treatment recommendations for ART, imaging, and the risk/benefit analysis for these interventions when applying the Class results of the test.
- Three clinical practice gaps emerged during the consensus discussion for which the panel members agreed that the addition of 40-GEP testing has significant clinical utility:
- In escalation of care for lower-stage patients with high-risk tumors
- In de-escalation of care for patients for whom the risks of ART may outweigh the benefits
- In decision-making regarding elective radiation to the nodal basin
- The expert panelists also agreed with a report from a recent survey of members of the multidisciplinary Skin Cancer Outcomes (SCOUT) consortium that recommended ART be considered when risk of metastasis is 20% or higher
- There was agreement that a Class 2A or 2B result serves as a high or very high-risk feature for consideration in recommending ART, as the metastatic risk conferred by these two results is similar to those of poor differentiation and PNI
- For multi-disciplinary care, panelists agree that dermatologists should image these Class 2A and 2B patients and refer them to radiation oncology, with a recommendation for multidisciplinary tumor board discussion for patients with Class 2B results
- Radiation oncologists should discuss individual risks and benefits of radiation with all of their patients and integrate Class 2A and 2B results into the context of other high-risk features when considering radiation, with a stronger recommendation of ART for Class 2B patients
- Panelists also recommend imaging by the physician’s choice of preferred modality in SCC patients with 40-GEP high-risk Class 2A or 2B results
- Consensus was also reached that imaging is preferred over sentinel lymph node biopsy (SLNB), given the absence of clear benefit and the possible morbidity of that procedure
New publication: “Incorporating a Prognostic Gene Expression Profile Test into the Management of Cutaneous Squamous Cell Carcinoma: An Expert Consensus Panel Report” was recently published in the Journal of Drugs in Dermatology (JDD).
Read the article here.
![JDD Consensus Image JDD Consensus Image](https://info.castlebiosciences.com/hs-fs/hubfs/JDD%20Consensus%20Image.png?width=231&height=304&name=JDD%20Consensus%20Image.png)
This comprehensive literature review, along with the unanimous vote on the statements above, is of great clinical value and provides actionable insights. It further highlights the significant limitations of current clinicopathologic staging systems in accurately predicting metastasis in patients. It is imperative to identify a more precise method for assessing this risk in order to minimize the negative impact on patients' health and well-being caused by both cSCC and unnecessary treatments. The 40-GEP test has undergone extensive validation as an independent predictor of cSCC metastasis risk, surpassing the capabilities of traditional staging systems. When combined with these systems, it offers a more accurate and reliable prognostic assessment.
- There is data to support that specific genes influence cSCC clinical behavior
- The data supports the 40-GEP test’s ability to identify a subset of cSCCs that are at a high risk for metastasis
- The 40-GEP test provides clinically useful data for cSCC prognosis that is independent of the AJCC8 and BWH staging systems
- Adding 40-GEP data to the AJCC8 and BWH staging systems enhances the prognostic assessment of cSCC
- Test results can increase the precision and confidence in cSCC management decisions
- The 40-GEP test should be considered for use on cSCC tumors with at least 1 high-risk feature per AJCC8 and/or BWH and/or NCCN guidelines
- The 40-GEP test should not be used on cSCC in situ or invasive cSCC without a high-risk feature, or for patients that are not candidates for additional procedures or therapies
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