Abstract
Background Comprehensive genomic profiling (CGP) has become increasingly integrated into precision oncology; however, its real-world clinical utility in community hospitals outside the national cancer genomic core hospital network in Japan remains less studied. This study aimed to evaluate the implementation, feasibility, and clinical impact of CGP in a community-based hospital. Methods We retrospectively reviewed patients with unresectable or recurrent solid tumors who had not received systemic chemotherapy at our hospital between April 2021 and December 2025. Clinical outcomes, including the detection rate of druggable genomic alterations, the proportion of patients who received genomically matched therapy, and overall survival (OS), were compared between patients who underwent CGP and those who did not. Results Among 253 patients, 60 (24%) underwent CGP testing. Druggable genomic alterations were identified in 45 patients (75%), and seven patients (12%) received genomically matched therapy. Of these, 5% were treated within clinical trials, and 7% received approved targeted agents. Among patients who received matched therapy, the best overall response was complete response (CR) in two, partial response (PR) in two, stable disease (SD) in one, and progressive disease (PD) in two. Tumor-type-stratified analyses showed variability in actionable/druggable profiles and matched-therapy delivery across tumor types. No significant difference in OS was observed between the CGP and non-CGP groups (median OS: 22.9 vs. 23.0 months, P = 0.78). Within major tumor types, including colorectal, gastric, pancreatic, and biliary tract cancers, OS did not significantly differ according to CGP testing status. Among CGP patients, OS tended to be longer in those who received matched therapy, although the difference was not statistically significant. Conclusions Despite being conducted in a community hospital outside the cancer genomic core network, CGP testing was feasible and enabled a clinically meaningful proportion of patients to access genome-matched therapy at rates comparable to those reported from tertiary centers. Although CGP did not directly translate into improved OS, it provided valuable treatment opportunities and facilitated precision oncology in a regional care setting. Further expansion of accessible genome-guided therapies may enhance the clinical impact of CGP in community hospitals.