Advancing Biomarker Testing Across GU, Lung, and Myeloma Care

The use of biomarkers was among the key topics highlighted during an Institute for Value-Based Medicine^® (IVBM) event held in Nashville, Tennessee, on January 15, 2026. Experts from the region discussed how biomarker testing was playing a role in genitourinary (GU) cancer while also discussing how this testing in lung cancer could benefit patients overall. Other topics included multistakeholder partnerships in oncology and delivering targeted therapies to those with multiple myeloma.

Biomarker Testing Can Inform Oncology Care With Increased Uptake

There were several featured panel discussions surrounding the role of biomarker testing in oncology, specifically as it pertained to GU and lung cancers. Edward Arrowsmith, MD, MPH, executive vice president of therapeutics at Tennessee Oncology, moderated the panel, “Balancing the Scales: Multi-Stakeholder Partnerships in Oncology Value,” which included 3 other experts in the field: Kathryn Beckermann, MD, PhD, director of genitourinary cancer research at Tennessee Oncology; Camille Hill, PharmD, vice president of oncology pharmacy services at West Cancer Center & Research Institute; and Ruchika Talwar, MD, a urologic oncologist at Vanderbilt University Medical Center (VUMC).

Biomarkers, said Talwar, can inform care across the spectrum, including risk stratification for prostate cancer and making decisions around surgery, including biopsy. Biomarker testing has been used in GU in the past through prostate-specific antigen and tumor markers in testicular cancer, with many biomarker tests helping with clinical decision-making. However, there are still challenges when it comes to uptake of these tests.

Beckermann noted that barriers to germline and next-generation sequencing (NGS) testing still exist in prostate cancer, notably timing, patient education, and distinguishing germline from somatic variants. Improving uptake, she said, would take some work.

“I know we’ve been thinking about putting things in our order sets where it’s appropriate. Of course, physician education. We’ve done direct outreach to our patients through the patient care portal. I love this idea of partnering with our pharmacists to say, ‘You’re getting treatment for your first-line prostate cancer. Have you talked to your doctor about germline and somatic mutation testing?’”

Talwar also noted that there was low uptake of upfront genetic testing in those with prostate cancer despite there being guidance to perform this testing in high-risk patients.

“I think education…really comes first, especially because it’s a concept probably more familiar to this room, given that there’s a lot of oncologists here, and less familiar to urologists and urologic oncologists. They’re just not treating other cancers, and so they’re not used to this,” she explained. “I love the idea of protocolizing it in a way where it’s built into—whether it’s order sets, whether it’s a reminder—the patient starting advanced prostate cancer therapy or they’ve said yes to several risk factors.”

Hill stated that using pharmacy as a central navigator between the clinics and labs can help to reduce delays in lab turnaround in these cases to make sure patients receive their appropriate testing in a timely manner.

Talwar noted the role of circulating tumor DNA (ctDNA) in urothelial disease, specifically in how it can guide decisions on the use of neoadjuvant therapy and can play a role in bladder preservation strategies. Beckermann explained that data have shown that those with positive results on a ctDNA test have found benefit in using adjuvant therapy, which has led her to use ctDNA as a way to inform perioperative immunotherapy decisions.

Non–muscle invasive bladder cancer was also discussed, with pembrolizumab’s approval a notable step in treating the cancer. Talwar and Beckermann said that it is likely that epidermal growth factor receptor (EGFR) therapies would rise in interest and collaboration would be needed to support EGFR testing that was driven by NGS. Hill noted that cost should also play a role in these decisions.

“As we can imagine, from the patient perspective, it’s incredibly expensive, a lot of these. And so I guess I do want to point out, just making sure that we’re appropriately thinking through—with regards to feasibility—of patient assistance programs and that sort of thing that’s definitely needed in order for the patients to truly be able to experience these treatments,” said Hill.

Biomarker testing in lung cancer was also discussed in the panel, “Precision in Practice: Implementing Biomarker Testing in Lung Cancer,” moderated by Melissa L. Johnson, MD, chief scientific officer and director of lung cancer research at Sarah Cannon Research Institute. Amanda Cass, PharmD, BCPS, BCOP, a clinical pharmacist in thoracic oncology at VUMC; Dax Kurbegov, MD, FASCO, senior vice president of Sarah Cannon Cancer Network; and Robert Ramirez, DO, FACO, an associate professor of medicine in the Division of Hematology and Oncology at VUMC, were the expert speakers.

Ramirez pointed out that, just as with breast cancer, lung cancer treatment also benefits from biomarker testing. “Similar with lung cancer nowadays, we are at that point where we need all of those biomarkers because it makes such a big difference,” he said.

Kurbegov explained that it’s been a challenge to overcome the historical acceptance of only diagnosing non–small cell lung cancer or small cell lung cancer, as this does not often get the complete picture of the cancer. “For us, it’s really been [to] start with, culturally, what’s the right thing to do? Get the right treatment for the right patient at the right time. None of that happens if you don’t get the right diagnosis, the right profile, the right information on which to build those treatments.”

He recommended tissue-based testing and specimen acquisition to provide a better treatment plan for patients with lung cancer. Cass also emphasized that gaps still exist in treatment, with new drugs requiring specific platforms and prior testing not always being able to capture the current mutations.

“At the time they were diagnosed, they may have had the appropriate molecular testing, but at the point of progression, do they have the correct molecular testing? And knowing what platform we’re using and what drugs have been approved since then to see if we can maybe give the patient additional therapy are important,” she said.

All of the experts noted that transforming testing results into discrete data would be a benefit to everyone caring for patients. Cass explained that referrals and second opinions that are gained from other institutions can be smoother if the results of molecular testing are not buried in the electronic health record as a PDF. Johnson thought that the use of artificial intelligence to convert the PDF to discrete fields was a great move. Kurbegov agreed, noting that the discrete data are critical for clinical trials, making accessibility important overall.

Biomarker testing remains a vital tool in helping to diagnose the exact type of cancer that a patient has to present targeted therapy that can effectively treat the patient. Expanding both clinician and patient education on the tool is paramount in getting targeted therapies to all patients.

Multistakeholder Partnerships, Bispecifics in Multiple Myeloma Covered by Experts

The IVBM also featured panels on topics outside of biomarker testing. Bispecifics, targeted therapies, and chimeric antigen receptor (CAR) T-cell testing in multiple myeloma were the topics of the panel, “Scaling Innovation: Delivering Targeted Therapies, CAR T, and Bispecifics in Multiple Myeloma,” moderated by Rocky Billups, MS, vice president with HCA Healthcare/SCRI. He was joined by Bhagirathbhai Dholaria, MD, associate professor of medicine in the Department of Hematology and Oncology at VUMC; Adetola Kassim, MD, MS, director of the Adult Sickle Cell Disease Program at the Vanderbilt-Ingram Cancer Center; Hans Lee, MD, director of myeloma research at the Sara Cannon Research Institute (SCRI); and Olalekan Oluwole, MD, MPH, associate professor of medicine, Hematology/Oncology, at VUMC.

The relationship between CAR T-cell therapy and bispecifics was touched on during the panel, with Lee noting that there is a dilemma when it comes to whether CAR T-cell therapy should be administered before bispecifics or vice versa. Kassim explained that the oncology world has so many treatment options now but often physicians do not know how to use them.

“Sometimes we use them based on default. For example, your insurance will approve CAR T-cell therapy, but they won’t approve bispecifics. Or your insurance will approve bispecfics but they won’t approve CAR T-cell therapy. Or your patient lives in East Tennessee, they can’t afford to come and stay with you for 30 days, so by default you use bispecfics…Sometimes what we’re doing is not based on science, it’s really just based on what the insurance is telling us to do or what the default is,” he explained.

Oluwale spoke about study results that suggested that CAR T-cell therapy and bispecifics could achieve longer remissions compared with cytotoxic chemotherapy. “It shows that patients with bispecifics, the ones who are going to fail this therapy, they’re going to fail very early. And the second group of people who are going to have deep and durable response, they probably won’t need the ongoing therapy beyond 6 to 8 months of bispecific exposure,” he said.

Inpatient stays for CAR T-cell therapy can add to its overall costs, which is already expensive. Kassim said that sustainability could be an issue if physicians and clinics are not inventive when thinking about the future of CAR T-cell therapy. Remote monitoring can help to provide means of outpatient delivery without being any less safe than before.

Multistakeholder partnerships in oncology were also discussed during the panel, “Balancing the Scales: Multistakeholder Partnerships in Oncology Value,” moderated by Kate Baker, MD, MMHC, medical director of value-based care at Tennessee Oncology.” Joey Hollenbeck, PharmD, director of pharmacy business management at Tennessee Oncology; Samyukta Mullangi, MD, MBA, medical oncologist at Tennessee Oncology; and Sylvia Richey, MD, chief medical offer and medical oncologist at West Cancer Center, joined Baker for this conversation.

Hollenbeck discussed how partnerships between pharmacy and hospitals can help make sure that a patient is seen by a doctor who knows how to treat the patients and has the medications that they need. Richey highlighted the importance of having a single hospital partner to avoid payer fragmentation and to avoid patients having to go to multiple hospitals. With a partnership with Tenet, West Cancer Center is able to offer a broad umbrella of payers, which allows for outpatient therapy and inpatient observation. Remote patient monitoring is also helpful both in the hospital and at home, said Richey, as it is successful to CAR T-cell therapy and bispecific delivery.

The Inflation Reduction Act also has effects on health care delivery, with Hollenbeck noting that there are moving targets each year when it comes to reimbursement, which makes budgeting difficult. However, Mullangi noted that the Part D cap of $2000 was a “very patient-friendly move, especially for folks with cancer,” as it gave a limit to how much patients would need to spend on oncology care specifically.

Overall, this IVBM event focused on the collaboration between all clinicians and pharmacists to get the best care for the patients, offering a method of teamwork across CAR T-cell therapy and bispecific treatment plans as well as collaborating to interpret biomarker results. This collaboration is key to addressing all forms of cancer in a way that is both affordable and effective in patients needing oncology care.