Precision Oncology: Molecular Genotyping and Optimal Treatment of Metastatic Nonsquamous NSCLC - Episode 4
Decoding Lung Cancer Mutations: Navigating Molecular Profiling in Practice
Key opinion leaders Charu Aggarwal, MD, MPH, and Melina E. Marmarelis, MD, reflect on their institution’s practices with regard to molecular profiling and its impact on treatment pathways in the setting of metastatic NSCLC.
Transcript:
Charu Aggarwal, MD, MPH: Melina, talk to us a little bit about the procedures we are following at our institution for molecular genotyping. I know you presented at [the] World Lung Cancer Conference in Singapore about some of our interventional nudges. We’d love to hear about those and inform our audience.
Melina E. Marmarelis, MD: The first is on the tissue side. Thankfully, we have instituted a reflex pathway so that any nonsquamous, non–small cell lung cancer goes automatically into sequencing without the need for the physician to physically place the order. That certainly speeds up that process. The liquid biopsy process in the past has just been physician-to-physician if they think that they need it. But we felt that it was important to have that as a default pathway as well. So we created an EMR [electronic medical record]-based nudge intervention that occurs when a new patient calls in to make an appointment.
Based on a series of 3 questions about their disease, if they qualify, an order is placed automatically for liquid biopsy to be done at the time of the new patient visit. The physician, if they feel that’s not appropriate or they don’t want that biopsy, can cancel that order, but the default would be for that to happen. And we know that one of the barriers to doing molecular testing is [the physician’s] time and a physician thinking that they need to order it. So this takes away that part of it and allows it to be the default so that concurrent testing of both tissue and liquid can happen.
Charu Aggarwal, MD, MPH: Exactly. And I think that’s been such a huge asset to our program as we hear from all of our physicians that it really has improved our ability to comprehensively genotype our patients and do so in a timely fashion and introduce redundancy almost, right? We have the tissue going, but we’re also getting liquid so that if the tissue is inadequate, we at least have liquid, and if the liquid is inadequate, we have tissue. So we have these layers of redundancy and also make the process almost automatic, which is great.
Transcript edited for clarity.