Dr Corey Speers on Challenges Adopting Personalized Radiation Therapy

Ensuring that prognostic or predictive tests to help make decisions regarding radiation therapy are accurate and clinically validated remains a challenge, said Corey Speers, MD, PhD, assistant professor, radiation oncology, University of Michigan.

Can you discuss the current state of development of prognostic and predictive genomic-based signatures for radiation decision making?
So, this is an area of real active interest. As I mentioned, there's a number of signatures that have been published recently, that purport to be both prognostic and predictive or prognostic or predictive in making radiation specific decisions. In addition, some of the previous signatures that have been developed to answer chemotherapy response questions are being applied to radiation questions as well. And it remains to be seen whether those will be useful in the space, as well.

But we have both those previously derived signatures that are being applied to radiation questions, and it may be useful, and we have radiation specific signatures that have been developed and are being are being close to being brought to clinic that may really help guide those decisions.

What barriers to clinical adoption of personalized radiation therapy remain and what steps can ameliorate this process?  
Yeah, I think the biggest challenging in adoption is just really making sure that these tests do what we think they do that is. Anytime you develop a test, you have to apply it to different patient populations, and kind of a blinded way or run clinical trials that ask the question, does this test that we think give us information about response to radiation or lack thereof? Does it really do that repeatedly, reliably, over and over again? So, we need to test, or we need to test for validation in additional patient populations.

We also need to assess the clinical utility of these tests, is it really helping patients in the end and so the barrier to adoption is the completion of some of those validation studies. They're underway and we're starting to look at those now. But before this is ready to be adopted in the clinic, we have to make sure that the tests do what we say they do. We've done that clinical validation clinical utility testing. For signatures that predict response to chemotherapy, there are some signatures to predict response to endocrine therapy that are currently undergoing those same validation and utility studies. For the radiation question. Those studies are now ongoing in terms of validation. That's the barrier. So, once those show that they do what we think they do, then they'll be ready for clinical use.
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