Author of

• 32148

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  EP1.14 - Targeted Therapy (ID 204)

  • Event: WCLC 2019
  • Type: E-Poster Viewing in the Exhibit Hall
  • Track: Targeted Therapy
  • Presentations: 1
  • Now Available
  • Moderators:
  • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall

  • 32174

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    EP1.14-21 - Implementing Precision Medicine in a Community Cancer Center to Impact Outcomes in Lung Cancer (Now Available) (ID 2649)

    08:00 - 18:00  |  Presenting Author(s): Elizabeth Hassen
    • Abstract
    • Slides

    Background
    

    With the majority of cancer patients being treated at community cancer centers, it is important to recognize the need for implementation of a Precision Medicine program in community-based oncology programs (Levit et al, 2019; Madhavan et al., 2018; Davis et al, 2018). Increasing indications for targeted therapies and immunotherapies drive the need for molecular testing so patients receive personalized treatment to impact quality outcomes (Gagan & Allen, 2015; Freedman et al., 2018).

    Method
    

    Retrospective review of Precision Medicine program and use of molecular testing.

    Result
    

    The Precision Medicine program was established October 2016 recognizing the need for structure and administrative support. Several key committees were formed including: Steering Committee with administrators and medical staff; Scientific Advisory Board for approval of genomic test; and Operations Committee for review, approval, and accountability, which are responsible for promoting and implementing Precision Medicine. A Precision Medicine team was formed to educate, expand testing availability, and establish policies and procedures within the healthcare system. The Scientific Advisory Board has reviewed and approved genomic test based on scientific validation.

    The multidisciplinary Lung Advisory Board has evaluated NCCN and College of American Pathologist guidelines to approve lung biomarker reflex testing for lung cancer patients. Currently PD-L1, EGFR, BRAF, ROS1, and ALK are reflexed for diagnosis of lung adenocarcinoma, and for squamous cell lung, PD-L1 is reflexed. Since January 2017, 2% ALK positive, No ROS1, 3% for BRAF, and 10% for EGFR mutations. PD-L1 combined positivity of high and low expression has been >41%. The population reviewed has an 85% current or past smoker rate.

    Next-generation sequencing (NGS) is physician ordered, and has increased utilization, 164 in 2017 to 225 in 2018, and trending to over 300 in 2019. For patients with NSCLC stage III and IV, about 20% have NGS. Education and recognition of limited tissue has led to increased use of liquid biopsy, 1 in 2017, 5 in 2018, to 21 in the first quarter of 2019, with lung cancer being 45% of cases.

    Conclusion
    

    A Precision Medicine program provides education, resources, and processes to the healthcare system and multi-disciplinary team to ensure appropriate genomic testing is used to guide personalized medicine and quality outcomes. The approval of reflex testing for non-small cell lung cancer diagnosis allows identification of key targetable mutations for treatment decisions.

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