The oncology field is experiencing profound change. The paradigm has shifted in how we treat patients, how we diagnose them and the therapies we employ. For example, consider the growing number of biomarkers for cancer. We’ve gone from fewer than six in 2005 to more than 50 in 2019 to nearly 120 this year. Some of these markers are prognostic, some are diagnostic, some are therapy selective. The evolution of our knowledge has exploded. With the advent of artificial intelligence, the use of digital pathology and the continued advancement of technology in oncology, we’ll only gain a more comprehensive approach to understanding cancer and the patient.
At the Cutting Edge of Testing: Blood-Based Diagnostics
One important topic in oncology is blood-based tests. Liquid biopsies may still be in their relative childhood, but thanks in part to the number of biomarkers to look for, they are quickly becoming standard in oncology testing. Tissue is unlikely to ever be supplanted, but blood-based testing is shaping up to be a strong partner of therapy selection, and potentially prognostics and diagnostics as well.
Colorectal cancer is a great example of a disease state where the screening test is somewhat invasive (that is, a colonoscopy) and people are reluctant to undergo the procedure. If we could identify patients at elevated risk of this disease through a blood assay based on venipuncture, it would be much more palatable to patients.
Our ultimate goal is to achieve true personalized medicine, where our treatment is tailored specifically for each patient. At the forefront of this goal is therapy response and disease monitoring. Novel approaches to minimal residual disease, which seek to identify patients who may benefit from additional therapy and monitor those who may have recurrence, are truly delivering on that promise of personalization.
The Mainstreaming of Bioinformatics
Bioinformatics has evolved rapidly since we started digitizing health records. Once they’re digitized, these records are mineable, which has driven our understanding of cancer and the evolution of the field. As we look to identify new biomarkers, therapies and targets, this information becomes a discoverable asset that furthers progress and creates a snowball effect.
With digital pathology, we’re able to marry the phenotypic expression of a disease with the genotypic components of that disease through molecular testing. The power of this approach coupled with patient outcomes will accelerate and revolutionize our understanding of cancer care.
Build Versus Buy
There remains the obvious question of whether it is better to decentralize molecular testing into the oncology clinic/health system or outsource and work with a reference partner. A major consideration for this should be the rate of change in molecular testing and oncology, which will cause many pieces of the highly specialized equipment purchased today to likely be outdated in two to three years. This translates to a failure to fully materialize the depreciation value of that equipment before it’s already out of date.
Partnering may be an attractive approach to meet the dual goals of sophisticated cancer testing and managing cost when you consider the rate of technology change, the cost of reagents, absorbing the cost of payer denials, the economies of scale required for economic viability and the payroll impact of skilled staffing to perform these kinds of tests. In fact, the skilled labor force required for this testing may be difficult to find in some markets, either from competition or scarcity of qualified individuals.
In addition to concerns around cost, complexity and even patient concerns that their genetic results might be sold to a third party, capability and cultural fit issues define a rewarding relationship between a health system and a lab partner.
Ultimately, the pathologists in your health system should have complete confidence in your lab partners so they can actively participate in the continuum of care and meaningfully contribute to the treatment as well as the diagnostic process. The health of your patients and your health system can only benefit.
Mark Kruzel, MD, is associate medical director, Oncology, Quest Diagnostics.
A Premier Corporate Partner of ACHE, Quest Diagnostics has been helping health systems get more out of their lab for decades. Together, we can unleash the full power of diagnostics to help improve patient and hospital health. For more information, visit ache.org/QuestDiagnostics.