Dr Stuart Goldberg: Biomarkers and Genomic Testing Can Impact Cancer Care

Several barriers exist when it comes to effectively integrating genomic testing and biomarkers into cancer testing and care, said Stuart Goldberg, MD, Chief of the Division of Outcomes and Value Research at the John Theurer Cancer Center at Hackensack University Medical Center.

Transcript

What can be done to increase the use of biomarker testing at community cancer centers?

The world is moving towards a concept of precision oncology, where we're trying to match the right patient with the right therapy. And in order to do that, you need to know a lot more about the patient. And that's where biomarkers come in. These are the genetic tests that we use to understand the disease better so that we can pick the right treatment. These tests now are commercially available. There are a lot of genomic companies out there, both solid tumors and liquid tumors. You can do liquid biopsy, you can do it on tissue biopsy, but they're commercially available. So it's not something that's only done in academic research centers. The community oncologist has access to this. We need just be able to think about it when we're seeing a patient and really coordinate the care with our pathologists, and with our pulmonologists, our gastroenterologist, to make sure the samples are obtained and sent. These should be done in the community and can be done the in the community.

What other changes need to take place on the part of both payers and health systems to increase genomic testing and oncology?

Well, genomic testing is no longer research. It's part of the actual care of the patient. It's part of what we use to decide what needs to be done. And I think that a lot of the insurance especially still consider it research and don't pay for these tests. They need to be re-educated, that this really is how we direct our care and how we pick the most effective, and also often, the most economic or most value-based therapy. So we need some education on the insurance side. On the physician side, it's a matter of staying on top of what are the changes, because these genomic tests are coming out faster and faster and new options, basket trials that have multiple treatments based on what genomics are out there. It's an education side for the physician to stay on top of it, but more importantly, we have to really tell our payers that this is not research. This is clinical care.

What are some examples of where biomarker testing for metastatic colon cancer reduced costs and improved patient outcomes?

Biomarkers are key in the management of colorectal cancer for the last 10 years. ASCO, the NCCN recommended that we test patients for specific mutations. I mean, EGFR mutations positive or predictive in a positive way, and also predictive in a negative way. So there are tests like HER2 where if you have that, you may want to think about in a gastrointestinal type patient, that these patients may respond to Herceptin or respond to a type of therapy. But more importantly, what we see in what used to be 40, now it's maybe up to 60 or 70% of patients, these markers can tell us when a patient should not be getting monoclonal antibody, that's very expensive, but we know won't work. So the NCCN and ASCO guidelines are really more geared towards making sure that patients don't get therapies that don't work because we have a biomarker that says that an EGFR drug won't work.