Precision Medicine in Oncology

With increasing awareness of genetic testing and advancements in precision medicine, more patients are seeking counsel from clinicians about what steps they should take if mutations are found. This requires physicians to become more informed, and a recent article discusses the hypothetical case of an Ashkenazi Jewish woman with breast cancer.

Pairing a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor with fulvestrant significantly improved overall survival (OS) for women with hormone receptor (HR)-positive, human epidermal growth factor 2 (HER2)-negative advanced breast cancer, according to 2 abstracts presented at the European Society of Medical Oncology 2019 Congress.

A recent study described the use of multiparameter flow cytometry to detect minimal residual disease, with an 8-color flow cytometric method with a 105 sensitivity, using monoclonal antibodies in dried formulation.

While measurement of minimal residual disease (MRD) at the end of induction is an important prognostic factor in acute lymphoblastic leukemia (ALL), there is a gap in education among community oncology providers, according to an abstract presented at the Society of Hematologic Oncology 2019 Annual Meeting.

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, discusses exclusion of men from the US Preventive Services Task Force's (USPSTF's) updated BRCA screening recommendation update.

Although minimal residual disease (MRD) is increasingly being used to predict treatment outcomes and as a surrogate marker of progression-free survival, there remains controversy over whether it is ready to be used in treatment decision making.

Nina Chavez, MBA, FACMPE, chief operating officer, New Mexico Oncology Hematology Consultants, Ltd., explains how expensive therapies like chimeric antigen receptor (CAR) T-cell therapy are creating reimbursement challenges.

While current guidelines recommend that only women with breast cancer who have a family history or who meet clinical criteria undergo genetic testing, a new cost-effectiveness analysis suggests that genetic testing should be expanded to all women with breast cancer.

As minimal residual disease (MRD) and other measures to detect cancer burden are increasingly used to predict outcomes and direct future treatment decisions, Amgen has chosen to partner with Adaptive Biotechnologies to use the clonoSEQ product to assess MRD across multiple drug development programs.

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, offers his view on the US Preventive Services Task Force's (USPSTF's) updated recommendation for risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.

Researchers found that post-chemotherapy minimal residual disease (MRD) subtypes were associated with a pattern of failure and time to failure.

Oncologists may be able to use circulating tumor DNA (ctDNA) to guide treatment decisions and predict which patients will have disease recurrence, according to 2 studies in JAMA Oncology.

The clinical significance of minimal residual disease (MRD) status was recently highlighted in The American Journal of Managed Care®’s Peer Exchange series “A Review of the Treatment for Multiple Myeloma.” During the series, key opinion leaders discussed the clinical implications and significance of MRD testing in patients with multiple myeloma.

All patients with metastatic breast cancer should undergo genetic testing based on the prevalence of P/LP variants in patients with metastatic breast cancer, which can have therapeutic implications.

Offering patients genetic counseling before and after they receive genetic testing is crucial for making sure they understand what the results mean, explained John Fox, MD, MHA, vice president of Clinical Transformation at Spectrum Health.

Monoclonal gammopathy of undetermined significance is a diagnosis of exclusion, but even once it has been identified, patients should not obsess over this precancerous condition, said Ajai Chari, MD, associate professor of medicine, Hematology and Medical Oncology, Mount Sinai Hospital.

While the results are early, if further research proves the approach effective, it could help boost the impact of treatments like chimeric antigen receptor (CAR) T-cell therapy, which to date hasn’t had much luck in solid tumors.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week in managed care, the top news included outcomes results in treating heart failure; US prevention experts said more women should get BRCA testing; the American Heart Association offered an advisory on treating high triglycerides with prescription omega-3 fatty acids.

The update to the 2013 recommendation includes a grade B recommendation that women with a personal history of breast, ovarian, tubal, or peritoneal cancer, and women with ancestry associated with BRCA1/2 mutations be assessed for the genetic mutations.

Outside of breast cancer, cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors have not been as successful as tumors develop resistance. New research shows that a murine double minute (MDM2) antagonist can help CDK4/6 inhibitors overcome resistance, offering a potential second-line treatment option in melanoma.

Researchers showed the potential of combining 2 precision medicines to overcome treatment resistance.

A Conversation With Chief Medical Officer Andrew Norden, MD, MPH, MBA

John Fox, MD, MHA, vice president of Clinical Transformation at Spectrum Health, reacts to the National Comprehensive Cancer Network's call to expand comprehensive genomic testing across several cancers.

A new understanding of how poly (ADP ribose) polymerase (PARP) inhibitors work could expand the patient populations who are treated, according to a study. The researchers also identified a potential biomarker to indicate which patients would benefit the most.