Dr Melstrom on Challenges Implementing Widespread Molecular Testing in GI Cancer

Laleh Melstrom, MD, MS, surgical oncologist, chief, Division of Surgical Oncology, Department of Surgery, asssociate professor, surgery and immuno-oncology, City of Hope, discusses the increased focus on, and advantages of, molecular testing to guide treatment selection for patient with gastrointestinal (GI) cancers, as well as barriers to the widespread implementation of biomarker testing.

Although germline testing has been essential in improving outcomes for patients with GI cancers, challenges still exist in its implementation. Melstrom begins by stating that he successful, large-scale adoption of biomarker testing is often hindered by limited access to and availability of resources, an overall lack of knowledge, and the timing of testing during the disease course. Obtaining comprehensive testing early in the diagnostic process can be particularly challenging, she adds. However, conducting such testing upfront may provide patients with access to clinical trials for which they may be eligible, especially in the second- or third-line setting, Melstrom explains.

A proactive approach to biomarker testing has been adopted by teams at City of Hope, Melstrom continues. This ensures that all patients undergo molecular profiling of their tumors at the time of presentation and, for those who are eligible to undergo surgery, following resection, she says. Comprehensive molecular profiling serves as a valuable resource in planning and strategizing for future treatment options, Melstrom asserts. By integrating this information into the patient's plan of care, the medical team can identify a patient’s potential eligibility for planned or ongoing trials as their disease progresses, Melstrom continues.

Overall, this approach emphasizes the importance of early and thorough biomarker testing, Melstrom says. Not only does this better inform immediate treatment decision-making, but it also helps position patients to participate in cutting-edge clinical research opportunities tailored to their unique tumor profiles, she concludes.