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Dr West

Cancer Ouija Boards, Umbrellas, and Baskets: The Evolution of Genomic Oncology

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Cancer treatment is in the midst of a transformation in real time.  Genomic testing of a tumor– looking for a wide range of dozens to potentially hundreds of markers at a time — is moving quickly from bleeding edge to mass adoption, at least in the US. This change is partly driven by ever-changing data and ever-changing clinical experience, partly driven by the general promise felt by patients and clinicians alike that new information will lead to vast improvements in our understanding and therapeutic options, and (lest we be naïve) partly driven by marketing from institutions and diagnostics companies who stand to gain by promoting this work.

That there are potential gains is undeniable – regardless of what the future may bring, even today it is a tangible gain to avoid missing the immediately actionable findings such as an EGFR mutation (for someone with  non-small cell lung cancer (NSCLC), for instance), but it can find many less common but clearly “actionable” mutations ranging from HER-2/neu to BRAF or a few others that are now mentioned in the guidelines developed by the National Comprehensive Cancer Network (NCCN) that typically lead to insurer coverage of the treatments recognized as effective for these rare mutations, which range from <1% to 3-4% of the lung cancer population.

But these tests are not going to offer only unmitigated positive opportunities. Aside from the cost of several thousand dollars per tumor profile performed, the results of these profiling tests most often reveal not a clearly actionable mutation, but one or more rare mutations that are accompanied by a synopsis of lab-based suggestions for unapproved and clinically untested options in that particular tumor type from the testing company. While a patient and their oncologist may say that they will ignore treatment options that are poorly studied and essentially just wildly speculative (there is a rather weak correlation between cancer treatments that work in the lab and those that are safe and clearly active in human cancer patients), that’s easier said than done. Instead, the molecular results often lead oncologists to be tempted to practice the black art of using the profile as a “medical Ouija board” to cobble together a treatment plan with no good clinical evidence to support it, all too often bypassing the treatments that are well established as helping improve treatment options in thousands of cancer patients with that tumor type. 

Ouija Board

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Dr West

Dr. Aisner Offers Glimpse Into the Future of Molecular Testing

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Dr. Aisner’s presentation on pathology and molecular testing ended with a discussion of what we can expect for improving the efficiency and perhaps lowering costs as molecular testing becomes more routine and the battery of tests we do for various cancers broadens.  Here’s her version of what’s coming, including the video and audio versions of the podcasts, as well as the associated transcript and figures for the program.

Aisner Pathol and Mol Path Pt 3 Testing Future Audio Podcast

Aisner Pathol and Mol Path Pt 3 Testing Future Transcript

Aisner Pathol and Mol Path Pt 3 Testing Future Figures

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Dr West

Dr. Dara Aisner on Practical Challenges in Molecular Testing

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Here’s the second part of the discussion between Dr. Aisner and myself, which included an introduction to the concepts of “What is pathology?” and “What is molecular testing?” along with a discussion of some of the limitations and pitfalls of molecular pathology today.  This section focuses on the practical challenges of molecular testing today, including which tissues are hardest to obtain results from, as well as the open question of whether “reflex testing” for molecular markers (when testing for a battery of targets is automatically sent for at the time a diagnosis is made) should be routine at many or most institutions. 

Below you’ll find the video and audio versions of the podcast, along with the associated transcript and figures.

Aisner Pathol and Mol Path Pt 2 Practical Challenges Audio Podcast

Aisner Pathol and Mol Path Pt 2 Practical Challenges Transcript

Aisner Pathol and Mol Path Pt 2 Practical Challenges Figures

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Dr West

Dr. Dara Aisner on Defining Pathology and Molecular Pathology

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I’m very pleased to introduce the first podcast from a terrific webinar program I did recently with Dr. Dara Aisner, pathologist and Co-Director of the Molecular Correlates Laboratory at the University of Colorado.   Dr. Aisner is a great communicator about topics that are very timely but can also be very complex.  Here, she introduces some basic concepts of what a pathologist does and what the new field of molecular pathology actually entails.  The program, co-sponsored by GRACE along with our friends at LUNGevity Foundation, is in the format of a back and forth question and answer session between Dr. Aisner and myself.

Here’s the first part, including the video and audio versions of the podcast, as well as the transcript and figures.

Aisner Pathol and Mol Path Pt 1 Defining Terms Audio Podcast

Aisner Pathol and Mol Path Pt 1 Defining Terms Transcript

Aisner Pathol and Mol Path Pt 1 Defining Terms Figures

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