Europe Oncology Genomics Tracker

Introduction and Methodology

• Survey Demographics
• Survey Scope and Definitions
• Survey Limitations / Considerations

Survey Findings

• Executive Summary: Genomic Profiling
• Executive Summary: MRD / Recurrence Monitoring, and Treatment Response Monitoring
• Executive Summary: Commercial Activity Perspectives

Survey Findings – Genomic Profiling

• In the past 3 months, what share of your newly-diagnosed patients received an NGS-based genomic profiling test for Tx selection? 
  
• Of those that received NGS-based genomic profiling testing in the last 3 months, what share was tissue-based vs. blood (ctDNA)-based?
• Of those that received NGS-based genomic profiling testing in the last 3 months, what share was small panels vs. large panels vs. WES / WGS?
• What is your level of awareness  / familiarity with each of the following genomic profiling providers (tissue  and / or blood-based)?
• Which companies do you perceive to have the strongest offerings in genomic profiling (including tissue and/or liquid)?

Tissue-Based Perspectives - Genomic Profiling 

• What share of your tissue-based genomic profiling in the past 3 months was performed using each of the following providers? 
• In the next 12  months, how do you expect your use of providers (by share) to change?
• For your top tissue-based genomic profiling vendor, what are the top 3 reasons why you order from this provider?
• What are your top pain points as it relates to comprehensive genomic profiling among tissue providers?

Blood-Based Perspectives - Genomic Profiling

• What share of your blood-based (ctDNA) genomic profiling in the past 3 months was performed using each of the following providers? 
• Over the next 12 months, how do you expect your use of providers (by share) to change?
• For your top blood-based genomic profiling vendor, what are the top 3 reasons why you order from this provider?
• What are your top pain points as it relates to comprehensive genomic profiling among blood-based providers?

Overall Genomic Profiling Company Perspectives

• Considering only the past 3 months, please rank up to 4 of the top genomic profiling companies by number of sales representative interactions
• In the past 3 months, how many times have you been contacted by sales reps about genomic profiling offerings from your top companies?
• Rank up to 4 companies that, in the past 3 months, had the most noticeable / memorable news, announcements, publications, etc. in genomic profiling

Survey Findings – MRD / Recurrence Monitoring

• How would you rate your familiarity with ctDNA-based MRD and monitoring testing in solid tumors? 
  
  • In the last 3 months, for patients receiving neoadjuvant treatment, what share received a blood-based (ctDNA) response monitoring test?
  • In the last 3 months, for patients within 6 months of completion of curative intent treatment, what share received a ctDNA MRD test?
  • In the last 3 months, for patients 6+ month from completion of curative intent treatment, what share received a ctDNA recurrence monitoring test?
• What is your level of confidence in the clinical utility / performance of MRD / monitoring testing?
• What is your level of awareness / familiarity with the solid tumor MRD / recurrence monitoring offerings from each of the following providers?
  
  • In the past 3 months, what share of MRD and monitoring testing was ordered from each of the following  providers? 
  • Over the next 12 months, how do you expect your use of providers (by share) will change?
• For your top MRD  / monitoring testing vendor, what are the top 3 reasons why you order from this provider?
  • Which companies do you perceive to have the strongest offerings in MRD / recurrence Monitoring?

Survey Findings – Treatment Response Monitoring

• How would you rate your familiarity with ctDNA-based treatment response monitoring testing in solid tumors?
• In the last 3 months, for your adjuvant stage patients within 6 months of 1L systemic Tx, what share received a ctDNA treatment response monitoring test?
  
  • Of those that receive treatment response monitoring testing, how many tests do patients typically get over the course of their treatment journey?
• What is your level of confidence in the clinical utility / performance of treatment response monitoring testing?
• What is your level of awareness / familiarity with each of the following treatment response monitoring offering providers?
  
  • In the past 3 months, what share of treatment response monitoring testing was ordered from each of the following providers?
  • Over the next 12 months, how do you expect your use of providers (by share) will change?
  • For your primary treatment response monitoring vendor, what are the top 3 reasons why you order from this provider?
  • Which companies do you perceive to have the strongest offerings in treatment response monitoring?

Survey Findings - MRD / Treatment Response Overall Perspectives 

• Considering the past 3 months, rank up to 4 of the top MRD / Treatment Response Monitoring companies by number of sales rep. interactions
• In the past 3 months, how many times have you been contacted by sales reps about MRD or Treatment Response Monitoring offerings from your top 4 companies?
• What are the top 4 companies you noticed had the most memorable news, announcements, publications, etc. in MRD / treatment response monitoring?

Appendix  – Intro to DeciBio

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Survey Scope & Design:

• Structured as a recall-based survey
• For most questions, respondents were directed to answer in the context of patients treated and/or experiences within the past 3 months
• Respondents were directed to answer in the context of patients treated in routine clinical care and not in the context of clinical trials
• For MRD and treatment response monitoring, respondents were directed to answer in the context of solid-tumor testing
• Logic was used to display certain questions to respondents based on prior responses (e.g., familiarity, testing rates, etc.); thus, not all respondents answered all questions (i.e.,respondents were not shown questions that were irrelevant to them based on their practices)

Respondents were provided with the following definitions while completing the survey:

Genomic Profiling: Testing for multiple genomic aberrations (e.g., indels, CNVs, fusions / rearrangements, single nucleotide polymorphisms) simultaneously using NGS in either tissue or blood samples to identify clinically-actionable genomic variants, primarily for treatment selection and/or clinical trial enrollment

Small panel: An NGS panel containing < 100 genes

Large panel: An NGS panel containing > 100 genes

Neoadjuvant Response Monitoring: ctDNA-based testing performed before and after neoadjuvant treatment to assess the response to neoadjuvant therapy / predict pathological complete response

Molecular (/Minimal) Residual Disease (MRD): ctDNA test performed one or more times within 6 months of completion of curative-intent treatment (typically after surgery) to check for residual disease and/or inform adjuvant treatment decisions (can be done before and/or after adjuvant treatment)

Surveillance / Recurrence Monitoring: ctDNA testing performed atone or more timepoints beyond 6 months post curative intent treatment (typically surgery +/-adjuvant treatment) to monitor for signs of molecular recurrence

Treatment Response Monitoring: ctDNA testing performed at one or more time points during or after treatment of advanced-stage patients with systemic therapy to assess the effectiveness of the treatment. Note that treatment response monitoring may include analysis of ctDNA levels, ctDNA variants, or both.

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Limitations / Considerations for the data contained in this survey include:

• Survey format: This is a recall-based survey, which relies on oncologists’ ability to recall specific information, which is imperfect
• Survey N: The 100 survey responses captured here represent a margin of error of 9-10% at a 95% confidence interval
• Stakeholder type: Oncologists are the primary stakeholder for deciding to order tests, but may or may not be involved in actually executing the order, thus the oncologist may not be entirely familiar with the details of the tests ordered (e.g., which types of tests from which labs)
• Definitions: Oncologists may have definitions that differ from those used / described in this survey and may have answered questions according to their personal definitions
• Selection bias: Oncologists that actively and regularly order biomarker testing are more likely to take a survey related to oncology biomarker testing, potentially over-representing adoption and utilization figures, especially for emerging methods‍
• Adherence to directions: Oncologists were directed to answer the questions within a specific context (e.g., solid-tumor patients treated within routine care (i.e., not trials) within the past 3 months) – it is possible that oncologists deviated from these guardrails when responding to questions
• Respondent mix: The mix of respondents by setting for this survey may vary from each individual country distribution and overall EU-5 distributions
• Volume vs. market share: Any share figures here correspond to volume share and are not necessarily reflective of market share
• Early access users: Some clinicians / institutions participate in early-access programs which give them access to tests prior to public / commercial launch of an assay, which could be captured here