Adequate Biomarker Testing Remains Key Gap in Community Oncology Care: Urs Weber, MD

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Many patients with advanced thoracic malignancies are first diagnosed or initially treated in community settings before being referred to academic centers. Yet biomarker testing done in the community setting can often be inconclusive, as it’s based on ctDNA or specific rare genetic mutations.

These specific tests not only limit the scope of coverage for biomarker testing, but also expend scarce tissue samples, Urs Weber, MD, a thoracic oncologist in the Division of Medical Oncology at University of Colorado Anschutz Medical Campus, said in an interview with The American Journal of Managed Care^®.

“The biggest gap is in understanding what is actually adequate biomarker testing,” he said.

When receiving patients from a community setting, Weber said he’s seen numerous examples of ctDNA, or blood-based testing, come back inconclusive because cancer DNA isn’t always detectable.

“People get ctDNA testing, it comes back negative, there's nothing there, and they take that to mean that there's nothing to be found. But that's not true,” he said.

In these cases, he said clinicians then have to refer to a tissue sample. However, there is also variability in the efficiency of these tests depending on what biomarkers are being tested. Patients should receive comprehensive next-generation sequencing (NGS) testing to give patients the broadest coverage possible. However, some vendors still test for specific mutations.

“What happens there is you sometimes miss some of the rarer alterations because you're just not looking for them, and it's also using a lot more tissue,” Weber said.

Often, tissue samples run out because they’re being used for multiple hyperspecific biomarker tests instead of one comprehensive test like NGS.

“It's not that people don't know to get the testing. They do know to get it; they just don't always get the right quality of testing,” Weber said.