Advancing Precision Medicine Through Comprehensive Genomic Profiling (CGP) - Episode 12

Comprehensive Genomic Profiling: When to Retest Patients

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Oncologists explain scenarios for which they may retest patients previously assessed via genomic profiling.

Bruce Feinberg, DO: Mark, what’s your delay? First, the way the it works at Memorial [Sloan Kettering Cancer Center], let’s say they’ve gone the surgical route. Are they coming to you with the full panel when you do your first evaluation? Are you ordering in most cases?

Mark G. Kris, MD: It depends on this evolving, and it depends on the nature of the biopsy material we have. This is going to send everybody off, but for thoracic cancers, we now have reflex NGS [next-generation sequencing] testing. At the time lung cancer is suspected, whether the biopsy is done by an interventional radiologist, a pulmonologist, or a thoracic surgeon, sufficient material is obtained for anatomic pathology—immunohistochemistry tests that support the anatomic diagnosis—and NGS.

Bruce Feinberg, DO: For our viewers, the concept of reflex testing is inherent to the understanding of the tumor. The pathologist looks at it, but also additional tests are performed. For breast cancer, this has been routine for decades because you can’t say it’s cancer and adenocarcinoma, ductal adenocarcinoma. You’d have to understand that it has estrogen receptor, progesterone receptor, HER2 [human epidermal growth factor receptor 2] overexpression, etc. The reflex testing concept is to take it 1 step beyond. That is part of the pathologic diagnosis. The diagnosis isn’t complete with that information. That’s fascinating. Kenna, is reflex testing done at [The University of Texas] MD Anderson [Cancer Center] yet?

Kenna R. Mills Shaw, PhD: Outside of breast cancer, no.

Bruce Feinberg, DO: There’s going to be a conversation tomorrow, or as soon as this airs, if Memorial is doing it and you’re not.

Kenna R. Mills Shaw, PhD: But our clinicians order it. The reality is that we have so many patients who walk in the door with their commercial sequencing. I had a patient who came in with their MSK sequencing in hand. We don’t rerun an assay that’s already been run, frankly. If somebody walks in with an MSK test result, we don’t think our assay is better than MSK’s. We love MSK-IMPACT; we take it. We reinterpret it by our precision oncology decision-support team to get optimal trials—that just-in-time response. But if a good NGS assay is done by a reputable group, we consider it equivalent, regardless of who did it. We do not do reflex for that reason.

Transcript edited for clarity.