Challenges in interpreting comprehensive biomarker testing and a few paths to address them

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Published: 7 Jul 2023
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Dr Howard Jack West - City of Hope Comprehensive Cancer Center, California, USA

Dr Howard Jack West speaks to ecancer about the challenges in interpreting comprehensive biomarker testing and a few ways to address them.  

The are many steps to executing optimal molecular oncology treatment. The tissue has to be obtained and sent after making a diagnosis, the full appropriate molecular testing has to be completed, then the results are obtained, and in the end, the oncologist has to review the report and make an optimal recommendation to start the right treatment. 

Dr West explains some of the ways in which there can be some mistakes and issues within these steps and how they can be overcome. 

What was your talk about?

My topic was about the concept that I would now consider converting from the red zone, to borrow a football analogy, of the complex process of so many steps required to execute optimal molecular oncology treatment. You have to get the tissue, you have to send the tissue after making a diagnosis, have the full appropriate molecular testing completed, there’s the turnaround time, getting the results back, and then having the physician, the oncologist who receives it, review the report and make an optimal recommendation and start treatment that would be optimal based on what the results are.

There are many points where things can go wrong along the way, but, in fact, as we get better at solving some of the issues like prioritising, getting enough tissue, and getting oncologists to send broad next generation sequencing, do liquid biopsies if there isn’t enough tissue, we still have this challenge of oncologists seeing the results, interpreting the results, and making an appropriate recommendation for that best treatment. So, even if you get to that last step, into the red zone, crossing the goal line and scoring, and getting the patient on the right treatment is more elusive than we’d like it to be, and we need to study this more and really help support oncologists, particularly with the interpretation process. Because they, in general, have not been trained as expert molecular oncologists. Most oncologists were trained before molecular oncology became commonplace and there’s advances being made all the time, which is great for the field, but of course it’s difficult for oncologists, particularly those who are treating ten or twelve different kinds of cancer every day, to keep up with the latest new molecular targets and therapies that are coming out every few months. So we really need to work on decision support to help these oncologists and make it easier for them to identify and execute the best treatment for patients. 

What is the importance of having events such as BEST of ASCO?

The impact right now is that we really need to better ask the question of what is the limitation, how prevalent is it, really what gets measured gets done. And so we really need to focus on this, acknowledge that it is a real issue, and acknowledge that what we do now, which is just drop these results off in a 70-80 page report onto the desks, into the inboxes, of oncologists, is not sufficient. That we cannot realistically expect 30,000 oncologists in the United States to all become knowledgeable about so many targets and treatments and we need to figure out better ways to do it. So at this point, the biggest issue is just clearly identifying the problem, and then we can turn to the best ways to address it.