Introduction of whole genome sequencing as NHS standard of care for glioma patients in two neurosurgical oncology centres: West Midlands

Background
The challenges of introducing Whole Genome Sequencing (WGS) as NHS standard of care for patients with glioma are reviewed.

Methods
Patients undergoing glioma surgery with WGS sampling were identified retrospectively from WGS reports between 01/01/2022-30/12/2023. Data including demographics, integrated molecular diagnosis, time through critical pathway steps per calendar quarter (Q) and WGS variants were captured from electronic health records.

Results
146 glioma samples were analysed. 91% of patients underwent craniotomy and 1 cm³ tumour sampled for WGS, with median tumour content (MTC) of 69.5% (IQR + /- 30.5). The remainder underwent stereotactic needle biopsy, and one core sampled for WGS, with MTC of 73% (IQR + /- 19%). Median time from tumour sampling to completion of WGS report in Q1:2022 was 255 days (IQR + /- 107.5) versus in Q4:2023 was 137 days (IQR + /- 60.5; p < 0.001). 26/146 (17.8%) patients had molecular variants leading to trial recommendation. 1 patient with glioblastoma and high Tumour Mutational Burden commenced anti-PD1 immunotherapy. 8 patients with glioblastoma had RB1 variants associated with improved progression-free survival.

Conclusions
WGS is feasible for patients undergoing biopsy or craniotomy. NHS infrastructural resources and improvement of WGS technologies are required to improve turnaround time and ensure equitable access for all patients with glioma.