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Supporting Access to Comprehensive Genomic Profiling


Considering the value of comprehensive genomic profiling, David Gandara, MD, highlights the importance of supporting access to testing.


David R. Gandara, MD: The field of molecular testing and cancer is moving so rapidly, that it’s hard for everyone to keep up. It’s hard for general oncologists seeing a variety of different cancer types to know what’s brand new in their cancer. It’s also hard for payers to know when they should approve something, when it should be still considered research, what is in transition. In transition in the past meant that you had a new drug, or you had a new test, and it was researched for 2 or 3 years, and then eventually it might reach standard of care. These days, the timeline has accelerated tremendously so that what was researched yesterday is the standard of care today, guidelines such as NCCN [National Comprehensive Cancer Network] can help with this but they can’t replace payers. For example, keeping up and knowing when they should approve something rather than issuing an initial disapproval or what has become overwhelmingly difficult for physicians and that is making a physician go through a peer-to-peer review for every little test. Sometimes that peer-to-peer review is not with someone who is a specialist in the field, so you’re explaining something and it’s beyond comprehension. The best way to make it optimal for our patients is communication and education. I have spoken at several meetings, for instance, managed care summits, next-generation summits, where the audience either consists of or largely is attended by the payers themselves, including CMS [Centers for Medicare and Medicaid Services]. Those interchanges have been positive. They have been informative for me as well as for the payers to know where they’re coming from. I have found that more in the United States that they understand. They understand why we need the testing. Now, the problem, of course, is that we have an entire worldwide population of cancer patients. In some other areas of the world it’s more difficult. Not only to do the testing, but it’s also more difficult if you find the abnormality and you don’t have the drugs, you haven’t done much for the patient. Nevertheless, our guidelines such as those from our own high IASLC, International Association for the Study of Lung Cancer, they apply worldwide and they help oncologists, medical societies, and other countries around the world bring this information to their governments and to the payers there so that they understand why it’s so important.

Transcript edited for clarity.

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