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UK Foundation Outlines Recommendations for Effective ctDNA Testing in Lung Cancer

NEW YORK (GenomeWeb) – UK health policy think tank PHG Foundation has released a report detailing recommendations on developing effective testing services for circulating tumor DNA in lung cancer patients.

The report was informed by a workshop the foundation held in March 2017 — which included input from clinicians, UK National Health Service clinical scientists, and representatives from the life science and biotech industry — to identify and focus on the most pressing issues affecting the implementation of effective and equitable ctDNA testing.

Specifically, the group focused on how the testing could help a subset of patients with non-small cell lung cancer (NSCLC) who can be treated with tyrosine kinase inhibitors that target mutations in the EGFR gene. "These patients require a genetic test in order for the clinician to prescribe the therapy. Due to the challenges associated with carrying out a biopsy to collect a solid tumor sample for testing, many patients miss out on genetic testing," the report noted. "In patients for whom biopsies are possible approximately 30 percent of biopsies fail or do not yield enough material for a genetic test."

The report concludes that ctDNA testing can help these patients and perhaps bring them closer to being treated with targeted therapies.

"The development and provision of ctDNA testing for patients with NSCLC by NHS laboratories in the UK is a positive advance," Laura Blackburn, policy analyst at PHG Foundation and lead author of the report, said in a statement. "Not only is this testing increasing access to targeted therapies that improve patient outcomes, but it is also a less invasive method of testing as it only requires a blood sample, and benefits patients who are unable to undergo a solid tumor biopsy for clinical reasons or who have had a failed biopsy."

The report calls for clinical experts within the UK health system to take the lead in raising awareness among clinicians about ctDNA testing technology, and the possible benefit to their patients. It also says that the effective and widespread use of ctDNA testing should begin with the professional societies and organizations in the UK developing clinical guidelines on the use of ctDNA testing in NSCLC patients.

The report includes recommendations for logistical considerations. For example, it suggests that laboratory websites should include up-to-date and clear electronic referral information and resources, including testing information, costs, and logistics for patients to refer to once ctDNA testing becomes more widespread.

Further, the report recommends that NHS England consider how patients can gain improved access to funded targeted therapies, and develop policies to ensure that the health system is prepared to implement targeted therapies when necessary.

The full report can be found here.