As the number of approvals for targeted cancer drugs continues to soar, genomics advocates have raced to get oncologists up to speed on how to routinely use these testing results when making treatment decisions for patients. So far, most of these “early adopters” have been physicians in academic medical centers.
Now, there’s an industry push from commercial labs and health care providers to motivate oncologists in community settings to embrace genomic testing. Such efforts include offering streamlined prescribing and reimbursement, launching physician and patient awareness campaigns, and developing better patient educational tools.
“We have so many examples now of targeted therapies. Finding the right one at the right time makes a big difference in a patient’s life. The technology has gotten cheaper, and the sophistication of analysis has gotten better, so it’s becoming standard of care,” said Lee Schwartzberg, MD, FACP, chief medical officer of OneOncology, a network of 6 community practices across the country. Last month, Dr Schwartzberg moderated a panel discussion titled “Power and Potential of Genomic Profiling in Cancer” at the 2020 Community Oncology Alliance (COA) Annual Conference.
“Community oncologists are excited about these new developments, yet reaching them has been a challenge. With next-generation sequencing (NGS), we might get more information than we know what to do with, and it might be overwhelming for a community oncologist to process that kind of information when they’re dealing with so many kinds of cancer and seeing 20 to 30 patients a day,” said Dr Schwartzberg, who’s also medical director at West Cancer Center and Research Institute in Memphis, Tennessee. In fact, one 2019 report by the American Society of Clinical Oncology (ASCO) that summarized community providers’ concerns found that many clinicians lacked the “experience and time to independently analyze, interpret, and apply” such data.1
Reaching community providers is a priority, experts say, because that’s where more than 70% of US cancer patients receive their care.2 Community hospitals often lack the capacity to conduct their own DNA testing, so they often send away patients’ blood or tumor tissue samples to an academic partner or a third-party commercial lab. “Even though these reports give some guidance about how to think about the results, the degree of guidance changes from lab to lab,” said Dr Schwartzberg. “When it’s not a common variant, the community oncologist might be unsure how to use that information.”
So far, adoption across the industry has been slow; an internal survey by commercial testing provider Foundation Medicine found that only 60% of advanced cancer patients receive any kind of genetic testing, and lung cancer patients were disproportionately represented because doctors were more aware of recent drug approvals that matched specific mutations. And only 17% undergo the type of comprehensive profiling that identifies multiple genetic variants and/or tumor biomarkers (as opposed to assays that focus on a single or a handful of mutations). The reports that are sent to doctors and patients also include a list of clinical trials that are recruiting patients who have similar genetic profiles.
Yet, the percentage of patients who undergo broad profiling is much lower among community hospitals and private practices. Not only is there a steep learning curve for clinicians, including keeping track of new drug approvals and constantly changing guidelines from the National Comprehensive Cancer Network (NCCN), there’s uncertainty about reimbursement from private insurers, and participants in the ASCO report said that cost and lack of insurance reimbursement were main reasons they avoided ordering sequencing tests. (In January, the Centers for Medicare & Medicaid Services announced3 it would pay for diagnostic laboratory tests for Medicare patients with germline tumor mutations in ovarian or breast cancer, which is an expansion of its 2018 decision to cover patients with advanced cancer.)
In an attempt to make the ordering and reimbursement processes easier, CVS Health launched a pilot program in December 2019 with insurer Aetna and commercial testing company Tempus Labs across 12 states.
An electronic portal informs oncologists of the availability of broad-panel genetic testing at the time of patients’ cancer diagnoses and then based on the results, suggests available treatments in alignment with NCCN guidelines. Those treatments “will automatically receive prior authorization approval, avoiding the need for additional approvals, and speeding time to start of the therapy for patients,” said Prem Shah, executive vice president of specialty and product innovation at CVS Health. “Transform Oncology Care uses genomic testing results at the point of prescribing to help patients start on the best treatment faster, and matches eligible patients to clinical trials.” Shah said that the approach aims to lower costs overall.
Several testing companies are also working to increase awareness of sequencing among physicians and patients. Earlier this month, Guardant Health, which develops blood tests to detect and monitor lung cancer, launched the “Clear Your View” campaign aimed at 10,000 oncologists nationwide to encourage them to test all patients with newly diagnosed advanced non-small cell lung cancer for 10 biomarkers. “Do not proceed with first-line therapy without a clear view ahead,” urged the reference guide that was developed with the help of 3 lung cancer patient organizations.