Innovative biomarker testing initiative in a community oncology setting.
Authors: Brisbin Lorraine , Berry Brittnie , Schuchart Trey , Ruiz Frederico , Mirsalehi Ayda , Dave Neal , Paulson R. Steven , Prakash Sucharu , Prakash Shikha 
Published: October 2023

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Background: It is well documented that biomarker testing in cancer lags far behind recommended guidelines. To improve testing rates and provide patients access to targeted therapies and clinical trials, a Precision Medicine Quality Initiative (PMQI) was launched across Texas Oncology in July 2022 and is ongoing. The PMQI recommended testing all eligible advanced solid tumor patients utilizing a broad panel next-generation sequencing (NGS) test on somatic tissue or with a liquid biopsy. This study assessed the impact of the initiative on biomarker testing rates and various testing metrics. Methods: This retrospective study analyzed data on biomarker testing during the period of Jan 2022 to Mar 2023. The target population included patients from Texas Oncology (largest private community oncology group in the country) with a diagnosis of advanced “solid tumor” (non-hematologic malignancy). Per PMQI, biomarker testing was ordered through Trapelo (online clinical decision support tool) or Precision Medicine Team. The order was tracked through IknowMed (EMR system) and CareEvolve (provider facing, customized database tracking orders/results real-time). This study analyzed data in CareEvolve to assess tests ordered per month, by tumor type, somatic vs liquid biopsy, small gene panel vs broad panel tests, labs utilized and by geographic region. Results: Biomarker testing rates increased by 150% after the launch of the PMQI (from average of 1378 tests/month before, to 2046/month after). Tests more than doubled during study period - 1213 tests in Jan ‘22 to 2602 in Mar ‘23. Testing was performed in all tumor types, including breast (14%), lung (22%), colorectal (15%), pancreatic (6%) and others. 79% of total tests were somatic broad panel NGS, 16% were NGS on liquid biopsy, and 5% were single gene/small panel tests. 6442 tests were early-stage cancer prognostics. Caris was the most used lab (35%). After the PMQI, somatic NGS orders increased by 53% (from 800 to 1230/month) and liquid biopsies increased by 101% (from 134 to 269/month). The highest increase in testing was in the regions of West Texas (154%) and Gulf Coast (176%). Conclusions: This study shows the success of the PMQI- biomarker testing increased across all tumor types, theoretically providing increased access to targeted therapies and clinical trials. Increasingly, broad panel NGS tests were ordered instead of single or small gene panels. Liquid biopsies more than doubled (can be effective in overcoming challenges of testing in community). Testing increased in rural/underserved regions of the practice, suggesting that such an initiative may reduce disparities in access. Even though this study showed increased overall testing, it was not designed to assess testing rates in all eligible patients. this study confirms that with coordination between providers, PM liaisons, Pharmacy, and Labs, such a complex, large scale and first of its kind initiative can be feasible and effective.