At the 2021 Community Oncology Alliance (COA) Annual Conference, a panel of experts discussed biomarker testing and therapeutic strategies in oncology.
The panel, moderated by Bobby Green, MD, chief medical officer, Flatiron Health, highlighted the promise of personalized medicine in oncology care.
Participating in the panel alongside Dr Green were Martin Dietrich, MD, PhD, medical oncologist, Florida Cancer Specialists, assistant professor of internal medicine, University of Center Florida Cancer Center; Geoffrey Oxnard, MD, vice president, global medical lead, Foundation Medicine; Byeong Yoon, executive director, oncology global medical affairs, Amgen; and Anthony Sireci, MD, vice president, diagnostics development & medical affairs, Loxo Oncology, Lilly.
Dr Green first asked the group how they decide which patients get biomarker testing. Dr Dietrich led the discussion by stating that he thinks every patient with a metastatic cancer diagnosis should have a panel done at the beginning.
“The sequencing of somatic mutations is covering two things at the same time. It's looking at hereditary alterations and somatic mutations on top of it. That information in my opinion is always of value. I've never had a test I felt like, ‘Well, that information is really not helping me,’” said Dr Dietrich.
Dr Oxnard agreed, further stating, “One thing that really resonated, which is the earlier you do it, the more value you can get. If you sort of delay it until you've learned through therapies, then you might not actually have as much potential to benefit from it.”
Dr Sireci presented another question to Dr Oxnard and Dr Dietrich about the role financial cost plays in the decision to test patients and how they manage and navigate that in clinical practice.
Dr Oxnard noted that some of the barriers they had faced in the past have improved with expanded coverage from Medicare and private payers, but that there is still some sensitivity with payers.
“I think if a payer would take a comprehensive approach, they would actually find that next-generation sequencing is not only cheaper than single gene testing, but more importantly—in the whole cost analysis, if you think about all the things you can rule out by properly testing with NGS—it’s actually a cost saving measure altogether,” said Dr Dietrich.
Moving the discussion to health care disparities, Dr Green stated that one-third of cancer deaths can be prevented if socioeconomic disparities were eliminated. Dr Sireci noted that some of the disparities are driven by payer policy, with many discrepancies between public and private payer systems.
Mr Yoon chimed in, stating that this is a complex issue and will require a lot of collaboration between different stakeholders to address the entire continuum of care. Dr Oxnard is hopeful that the FDA approval of liquid biopsies will help close the gap through accessibility.
“Making testing available, making it accessible is within reach, I think. The FDA approval of liquid biopsies finally makes that within our grasp,” stated Dr Oxnard.
“I cannot tell you how many different logistical obstacles liquid biopsy solves,” added Dr Dietrich.
“Liquid biopsies obviously help with some of the operational challenges because you don't need to get the tissue,” said Dr Green, leading him to ask the group when a patient should get liquid biopsy vs tissue.
Dr Oxnard explained that the two modalities fit together, and clinicians need the flexibility to use both. “You have to use the tissue when you have it, because it does give you the highest quality result,” he said, but for situations where tissue is not available, having the ability to send off a blood test to get results back as quickly as possible is important to deliver timely care to patients.
The panel closed by highlighting some of the biggest recent advancements in precision medicine, including the FDA approval of liquid biopsies, and the development of several new therapies requiring biomarker testing. “I think over the last six months, we've had at least eight or nine new therapies that are requiring biomarker testing. That is not a trend that's going away, so we’ve got to figure this out all together,” stated Mr Yoon.—Janelle Bradley