Comprehensive Genomic Profiling: When to Retest Patients – AJMC.com Managed Markets Network

Bruce Feinberg, DO: Mark, whats your delay? First, the way the it works at Memorial [Sloan Kettering Cancer Center], lets say theyve gone the surgical route. Are they coming to you with the full panel when you do your first evaluation? Are you ordering in most cases?

Mark G. Kris, MD: It depends on this evolving, and it depends on the nature of the biopsy material we have. This is going to send everybody off, but for thoracic cancers, we now have reflex NGS [next-generation sequencing] testing. At the time lung cancer is suspected, whether the biopsy is done by an interventional radiologist, a pulmonologist, or a thoracic surgeon, sufficient material is obtained for anatomic pathologyimmunohistochemistry tests that support the anatomic diagnosisand NGS.

Bruce Feinberg, DO: For our viewers, the concept of reflex testing is inherent to the understanding of the tumor. The pathologist looks at it, but also additional tests are performed. For breast cancer, this has been routine for decades because you cant say its cancer and adenocarcinoma, ductal adenocarcinoma. Youd have to understand that it has estrogen receptor, progesterone receptor, HER2 [human epidermal growth factor receptor 2] overexpression, etc. The reflex testing concept is to take it 1 step beyond. That is part of the pathologic diagnosis. The diagnosis isnt complete with that information. Thats fascinating. Kenna, is reflex testing done at [The University of Texas] MD Anderson [Cancer Center] yet?

Kenna R. Mills Shaw, PhD: Outside of breast cancer, no.

Bruce Feinberg, DO: Theres going to be a conversation tomorrow, or as soon as this airs, if Memorial is doing it and youre not.

Kenna R. Mills Shaw, PhD: But our clinicians order it. The reality is that we have so many patients who walk in the door with their commercial sequencing. I had a patient who came in with their MSK sequencing in hand. We dont rerun an assay thats already been run, frankly. If somebody walks in with an MSK test result, we dont think our assay is better than MSKs. We love MSK-IMPACT; we take it. We reinterpret it by our precision oncology decision-support team to get optimal trialsthat just-in-time response. But if a good NGS assay is done by a reputable group, we consider it equivalent, regardless of who did it. We do not do reflex for that reason.

Transcript edited for clarity.

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Comprehensive Genomic Profiling: When to Retest Patients - AJMC.com Managed Markets Network