Download Christopher Corless, Chief Medical Officer, OHSU

Molecularly-Targeted Cancer Therapy is Here
Why is Change So Hard?
Advances in DNA
Sequencing Technologies
• We can sequence DNA 1,000 times faster than just
a few years ago, for about the same cost
• The technology is robust and highly reproducible
between laboratories
• Instead of testing 1 to 3 genes in a cancer, we are
now testing 20-200 at a time
• Sequencing all 20,000 genes in the genome is
being performed in some labs and will become
commonplace in the near future
Clinical Utility of Broad-based
DNA Sequencing in Cancer
• Our lab conducted a recent study of 301 cases of
advanced cancer:
• A 37-gene panel was completed on all cases
• The results influenced patient care in ~20% of cases
• New options included:
• Entry into a clinical trial
• Use of a targeted therapy off-label
• In some cases, a decision not to use a particular
therapy
J Clin Oncol 32:5s, 2014 (suppl; abstr 11028)
Costs and Reimbursements
• The cost for sequencing a panel of 37 genes is only
~4 times the cost of sequencing 1 gene
• Most private insurers are reimbursing at ~40-50%
of charges, but some pay nothing
• However, 45% of patients with the most common
cancers are on Medicare
• In the eyes of Medicare, only half a dozen genes are
relevant to cancer and only these are being paid
• New billing codes for gene panels have been created
but are not assigned any $$ value
Summary
• There is an enormous and growing gap between
what technology can deliver and what is accepted
by payers as ‘standard of care’
• Opportunities to benefit patients with common
cancers (e.g. lung cancer) are being missed
throughout the country
• Laboratories that strive to make state-of-the-art
testing available are being financially penalized
• The FDA has announced it will begin to regulate all
laboratory-developed tests in the U.S., which will
add to costs and overall regulatory burden