Value-Based Use of Molecular and Genomic Markers
While genomic-oriented and molecular biomarker research is interesting and has practice-changing potential, “the goal of the genomic-oriented presentations at ASCO 2014 is to provide information on what is known, when it is cost-effective to order such assays, and how test results may be helpful in impacting patient care.”
However, underutilization of molecular biomarker testing may have significantly negative effects on clinical outcomes, thus negating any cost-savings from not ordering the tests. This is a significant problem in the management of patients with non-small-cell lung cancer (NSCLC), as was shown in an important presentation at today’s ASCO meeting. While current ASCO, CAP/IASLC/AMP, and National Comprehensive Cancer Network guidelines recommend testing tumor specimens from all patients with advanced nonsquamous (NS)-NSCLC for EGFR mutation status and ALK gene rearrangement, a presentation in which 385 US medical oncologists were surveyed for their utilization of biomarker testing revealed that only 10% of these providers followed the evidence-based guidelines and tested all their patients with advanced NS-NSCLC for these markers; 20% of the oncologists tested fewer than half of their patients for relevant EGFR/ALK biomarkers (Green MR, et al. ASCO 2014. Abstract 8097). These data highlight the fact that further education is needed regarding the optimal value-based approach to molecular testing in NSCLC for EGFR, ALK, KRAS, ROS1, RET, BRAF, ERBB2, NTRK1, and FGFR to define actionable mutations and molecular biomarkers that could be used to inform therapy.