Dr Davey Daniel on Barriers Limiting Genomic Testing Use in Lung Cancer

There remain several barriers impacting genomic testing and the use of precision medicine for lung cancer, which can delay patient care and lead to adverse outcomes, said Davey Daniel, MD, chief medical officer, OneOncology.

Transcript

As a lung cancer specialist, what has been your experience with patients who seek access to genomic testing to guide treatment?

[At] my personal practice, I found that fairly straightforward. I've been fortunate that I've had a series of clinical trials—and perhaps it's just payer mix and such—that I really feel like that as long as I have adequate tissue, I get great tissue testing. I've been an early adopter of using serum circulating tumor DNA for testing.

So I feel, in my practice, it's been fairly straightforward. But what I've learned [is] that it's not true across the country. When I talk to my colleagues that are in practices in California, just the payer structure is such that they can't get the testing they want.

I talk to other colleagues; they're reflex testing and they're iterative testing, where they do sequential testing, [and that] uses up all the tissue. So, those are real issues and it's delaying patient care—so we have to focus on that. I think physicians and medical oncologists totally understand the importance.

And when we look within OneOncology, we actually find really high testing levels and that most doctors are waiting until they have those results before dictating the first line of care. But I think it's clear that we need to make that faster, because some patients need to be treated quickly, and that any barriers to slowing that down may influence people to treat earlier than they would like to.

I do think there's a second component, and that's making sure there's appropriate interpretation. I think medical oncologists are pretty savvy, so driver mutations we can pick up pretty quickly. I think the next step we all have is identifying possible backup plans, including if there's a signature that suggests maybe a clinical trial option for that patient.

So, one thing at OneOncology we're doing is trying to just build out the precision medicine program, weekly molecular tumor boards. Hopefully that will make it easy for physicians to expand their knowledge, but also for that individual patient, focus on what the next steps are. We've been doing a series of educational tumor boards once a month on molecular cancer topics, and we'll continue that. But then we also continue weekly case-by-case reviews and discussions, and I've actually learned a huge amount from that.