All tumors should be genotyped. Why aren’t they?

There are huge benefits to genomic tumor assessment, both for better treatment now, and later, if first-line treatments fail. But I don’t think many cancer patients—and even some physicians—fully understand how important tumor sequencing can be to successful cancer treatment. Yet.

This is not surprising. Outside of a few tests for breast cancer, we really didn’t have the tools to do this sequencing even just five years ago. The first major breakthrough that I saw in clinical practice was for metastatic melanoma, a very rare clinical scenario where the incidence is maybe 10,000 cases a year. Suddenly in August 2011, there was a machine I could put in my lab, and in one day obtain results of a molecular test that had a tremendous impact on treating the patient, according to whether the tumor was BRAF positive or BRAF negative.

From that time on, there has been an increasing number of solid tumors where we can test for a genetic biomarker that indicates a specifically targeted treatment, such as the FDA-approved testing for EGFR in non-small-cell lung cancer and KRAS in colorectal cancer.

One point of controversy is clinical. Clinicians often don’t want too much information early on because it complicates their treatment planning. As a physician, once you know something, you become responsible for that information. It’s great to have a comprehensive test that provides all this detail about the tumor genetics, but the clinician is left having to figure out what this means for treatment. That may just be too much information at a time that’s not helpful, when you just need to implement a treatment plan.

Read the full, original story: Why the controversy? Start sequencing tumor genes at diagnosis

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