Molecular Markers and Underuse of Genetic Tests

by Don Jewler, Director of Communications, ACCC

In today’s new world of cancer therapies, tumor histology and molecular characteristics are critical clinical selection criteria for individualizing cancer treatment. We know anecdotally that community oncologists often order pathology tests, but many fail to routinely utilize the molecular and histologic pathology data to guide diagnosis, treatment selection, and predict response to therapy.

That’s why a new ACCC program is so important. The soon-to-be launched program is designed to educate the oncology community about the role of molecular markers to guide diagnosis and treatment selection for patients with non-small cell lung cancer (NSCLC).

Advances in understanding the pathogenesis of NSCLC have led to the development of molecularly targeted agents, including those targeting vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), and insulin-like growth factor (IGF-I) signaling. And equally important, new genetic tests are able to detect who has a specific genetic receptor mutation, which opens the possibility of directing specific therapies at the patients most likely to benefit from them.

Yet, some genetic tests may be underused.

Just recently, for example, a new study presented at a conference sponsored by the American Association for Cancer Research showed that the assay to detect the presence of EGF receptor (EGFR) mutations in non–small cell lung cancer patients is vastly underused in the United States. Patients with EGFR mutations generally respond better to certain therapies – such as erlotinib (Tarceva) and geftinib (Iressa) – that target these mutations.

The study found that the counties with the highest lung cancer incidence have the lowest rate of EGFR test use. Minorities and people with a lower socioeconomic and educational status, or those who live in rural areas, are not getting access to the EGFR test.

ACCC’s project will include continuing medical education activities that provide a pathway to practice improvement in the treatment of patients with NSCLC and a deeper understanding of molecular markers and genetic tests that detect specific genetic receptor mutations. Community oncologists who treat patients with lung cancer need access to new information, tools, and insights, which they can integrate into their practice to improve patient outcomes.

ACCC’s new educational project will include continuing medical education activities. A case-based clinical vignette tool will be developed to determine the current practice patterns of oncologists and assess perceptions, attitudes, and barriers that providers face in managing their patients. CME activities will help physicians interpret pathology reports, apply pathology data in treatment selection, interpret data for treatment response, and understand the overall impact on patient quality of life. Educational materials will also be developed to help patients choose a treatment plan, make the most of clinical visits, and understand treatment-related side effects, nutrition management of side effects, the importance of adherence to treatment, and how to maintain a healthy lifestyle.

The project is in collaboration with Rockpointe Oncology and CE Outcomes, LLC. The initiative is supported by educational grants from Lilly USA, LLC; Astellas; and Genentech.