The use of precision medicine and targeted therapies in the treatment of cancer is quickly increasing. However, implementing such approaches in the community, where most patients are seen, often remains a challenge. Clinicians struggle to identify which molecular diagnostic tests are right for their patients at a particular time in their disease trajectory, and to know which tests will provide accurate and actionable information. Many oncologists lack the experience and time to analyze, interpret, and apply the extensive information contained in comprehensive genomic reports, potentially limiting their value. Such tests can also be costly and insurance reimbursement remains uneven. Community oncology practices often face challenges related to the storage and retrieval of genomic data and laboratory results in electronic health records (EHRs). Lack of interoperability between EHRs and laboratories can make it challenging to match patients with clinical trials and identify those who may benefit from new treatments.
Because of these challenges, new technology and business models are emerging to help community hospitals and regional networks more successfully implement precision medicine therapies.
ThermoFisher recently debuted a new automatic NGS sequencer capable of turning around results from a pan-cancer assay panel in a single day — making it possible for smaller hospitals to offer high-throughput genomic testing in the same timeframe as single gene tests and at reasonable cost. The fully integrated Ion Torrent Genexus System requires minimal amounts of tissue samples from either fixed tissue or liquid biopsies and can conduct testing on samples as they arrive in the lab, rather than either outsourcing sequencing to an external lab, with a turnaround time for results of days to weeks, or limiting testing to a few narrow-focused single assays. The Genexus System includes an integrated sequencer as well as a purification system and reporting software. ThermoFisher plans to develop and seek approval for a menu of diagnostic assays to run on the system.
In addition, CVS Health announced in December a new strategy and collaboration aimed at transforming oncology care at the local level to improve patient outcomes and lower overall costs. CVS Health is partnering with Tempus, a technology company advancing precision medicine through applications of artificial intelligence/machine learning. The effort, delivered in close coordination with oncologists, will use broad-panel gene sequencing tests and the latest treatment and supportive care guidelines from the National Comprehensive Cancer Network (NCCN) to help oncologists identify and more quickly start patients on the most appropriate treatment based on their clinical and genetic profiles. Regimens that align to NCCN guidelines, including those matched with the results of broad-panel gene sequencing, are expected to automatically receive prior authorization approval, thus speeding time to treatment and lowering cost.
A web-based portal, built into the e-prescribing workflow, alerts oncologists to the availability of Tempus’ broad-panel gene sequencing tests at the time of patient diagnosis. The tests identify genetic variants and therapeutic options specific to a patient’s molecular and clinical profile. The platform also matches and supports the rapid enrollment of eligible patients in local clinical trials, and provides oncologists with real-time access to the latest NCCN guidelines. The system also includes CVS Health’s nurse-led care management, integrated with existing payer programs to personalize the care experience for patients, and other CVS systems to help identify and intervene with patients who could benefit from preventive or screening services.