Getting Personal With Molecular and Genomic Testing Across the Cancer Care Continuum

Cancer care is evolving at a fast pace as researchers gain increased understanding of the changes in genes, proteins, and other substances that cancer cells use to grow and spread. This research has resulted in new cancer treatments as precision medicine uses molecular and genomic outcomes to choose treatments that are helpful for specific patients while sparing others from therapies that are not likely to ameliorate their disease. Personalized precision medicine is not a one-size-fits-all approach—it tests for individual biomarkers in the genetic environment.

This testing is a major step at the diagnostic and treatment continuum of care phases. In the past 5 years, 60% of approved cancer treatments required or recommended biomarker testing before use.¹ Depending on why and how the testing is completed, there are several names for these tests, and some biomarkers can indicate various treatments that work best when the cancer cells have distinguishing characteristics that make them different from normal cells.² However, all patients are not benefiting from the latest advancements in biomarker testing. To fight this inequity, the American Cancer Society Cancer Action Network is working to expand insurance coverage for comprehensive biomarker testing and most recently has been successful in California with a law that will require government and private insurers to cover medically necessary biomarker testing.³ California is 1 of 15 states with laws that attempt to eliminate the cost barrier and expand availability and equitable access for biomarker testing.

During the outreach and screening phases of the continuum, multicancer early detection (MCED) technologies aim to complement traditional cancer screening programs. This is a suitable addition since more than 75% of cancer-related deaths occur from cancers for which we do not screen.⁴ MCED testing explores molecular signals with a noninvasive approach by using blood, breath, urine, saliva, or stool samples to look for multiple cancers in a single test.⁵ This technology is a work in progress as many questions on reliability and outcomes are captured and analyzed. Health equity is an active work group in this space, and patient navigation is a foundational piece.

The clinical utility of molecular and genomic testing will grow over time to improve care and close gaps in screening and other identified areas. It will become a natural part of the cancer care continuum framework as collaboration continues to advance cancer care for all.

References

1. Global Oncology Trends 2021. IQVIA Institute. June 2021. www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/global-oncology-trends-2021
2. American Cancer Society. Biomarker Tests and Cancer Treatment. www.cancer.org/cancer/diagnosis-staging/tests/biomarker-tests.html
3. American Cancer Society Cancer Action Network. Access to Biomarker Testing. www.fightcancer.org/what-we-do/access-biomarker-testing
4. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7-30.
5. Multicancer Early Detection Consortium. Communicating the impact of multicancer early detection technologies on improving cancer detection and outcomes for all. www.mced.info/