Dr. Nagourney's Blog

Are Genomic Screening Tests for Cancer "Over Promoted"?

By Robert A. Nagourney, MD

Patients with a new diagnosis of cancer generally react with a myriad of questions.

Is the diagnosis correct? How far advanced? Did I do something to cause this? Are my family members at risk? Are there effective treatments? And finally, will I survive?

Today, virtually everyone runs to the internet for information.

What they find instead is advertisements for cancer centers, drug promotions and a growing number of appeals from gene-profiling companies. Not surprisingly, many patients and their doctors have been lured to use DNA tests to answer their questions. But do these tests deliver?

A new survey by a group from Seattle sheds some interesting light on this question.

Survey Says...

Eighty-nine practicing hematologist-oncologists and 43 medical oncologists responded to a survey that inquired about their opinion, use and experience with gene-profiling tests. Of the responders, 87% had previously used genomic testing for their patients. 

When questioned, 55% of the responding physicians felt that “genomic testing is over promoted” and that “its value is low or far below expectations.” Among their concerns; 31% said that the tests rarely provided actionable findings, meaning that they couldn’t usefully apply the results to their patients  

They also voiced concerns over insurance coverage and over half were not convinced of the reliability and validity of the tests.

When an opinion leader from a major east coast university medical center was approached, he agreed that “relatively few patients actually benefit from next-generation sequencing.” In their defense however, he described the findings as somewhat “misleading” stating that as new drugs are developed these tests will become more useful.

While there may be some room for optimism, on that point, for now, the jury is still out.

Are We Betting the Farm on Genomic Testing?

Today in the US we spend $10 billion a year on genomically-targeted therapies. To put this in context, that is nearly twice the entire National Cancer Institute’s (NCI) budget for 2017. Despite these expenditures, we see from this survey that most clinicians have difficulty applying the results and even their biggest proponents admit their limited clinical utility.

Academics vs. Practicing Clinicians

This is an interesting era in modern Oncology.

While the clinicians who are responsible for most of the patient care delivered in the US find little utility in molecular screening, their university-based brethren continue to promote their use.

Are we to believe that the university investigators are right and the clinicians are wrong? Or is it possible that the clinicians, with their ear to the ground, are hearing the early rumblings of a ground swell of disappointment with modern cancer genomics?

This is not the first time that scientists have raised serious concerns about the use of gene profiles to select drugs. Many have already weighed-in that these gene tests are overhyped, oversold and underperforming.

Recently a flagship molecular profiling company based in Los Angeles came under scrutiny, as reported in the March 7th, 2017 Los Angeles Times. In a related interview in the journal STAT, Dr. Vinay Prasad from the Oregon Health Science University in Portland described this laboratory’s results as “less than modest.”

We Are More Than Our Genes

Human cancer biology is demonstrably more complex than its genes.

In response, our laboratory has long maintained that the ultimate path to discovery for cancer patients is through the study of each patient’s own tumor biology, not their DNA. We use our EVA/PCD platform to study cellular response to injury and with it we can measure drugs, combinations, synergy, targeted agents and metabolic inhibitors.

It is a sad commentary that today’s medical oncologists, fighting their patient’s very real cancers are encouraged to apply theoretical tools with limited clinical data to support them.

Are the doctors in the trenches who are entrusted to treat seriously ill patients so wrong? Or are the ivory tower investigators so wedded to their genetic tests that they are unwilling to admit the limitations of these approaches?

The coming years will tell, but as I read this recent survey, I could not help but be reminded of Hans Christian Anderson’s parable of the Emperor’s New Clothes. 

As always, I appreciate your thoughts and comments.

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