Barriers in Concurrent Testing for mNSCLC: Real-world Challenges and Solutions

Transcript:

Charu Aggarwal, MD, MPH: There’s just so much data out there in terms of the real-world impact of testing [for metastatic non–small cell lung cancer (mNSCLC)], as well as delivery of target therapy. What have you heard, Melina, in the community? And what challenges do you foresee in implementing such an approach? Tell us about some of our efforts.

Melina E. Marmarelis, MD: I think there is mixed enthusiasm for concurrent liquid and tissue testing. I would say the primary concern that people have is insurance coverage. And that I think is a real concern. It’s something that we need to work closely with payers on, given that doing concurrent testing, both tissue and liquid, can lead to an improvement in being able to detect a targetable alteration. And that leads to better and more personalized care for patients.

These tests are expensive, but compared to, again, immunotherapy, they are not nearly as expensive as unnecessary immunotherapy. So I think that’s a bit of an uphill battle, because it requires a lot of different players, and is something that we’re very passionate about and hoping to continue to advocate for. So I think that’s the biggest barrier. One of the other barriers, of course, is the anxiety of waiting for these tests. Turnaround time is really important, so anything you can do to shorten that I think will help ensure the appropriate therapy, most likely. And that’s where a lot of our efforts have been focused. Also, in the community, getting the liquid biopsy at the time of a new patient visit is the default, similar to what we have done at our main institution, which is kind of where we’ve focused our efforts at the moment.

Charu Aggarwal, MD, MPH: Yeah, it truly takes a Herculean effort to implement this and also make sure that physicians are actually looking at the results. We’ve said time and time again, it’s one thing to order the test, but it’s meaningless until and unless someone looks at it, interprets it, and acts on it.

Melina E. Marmarelis, MD: Yeah, and that’s been another, focus of this; these efforts are actually delivering the results in an interpretable way. Also, showing the types of therapies as well as clinical trials that might be available. So I think that’s a whole other barrier, which is the interpretation of these now complex results.

Transcript edited for clarity.