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NCCN Trends™: An Evaluation of the Use of Companion Diagnostic Testing and Targeted Therapies

Jake B. Guinto, PhD, Manager, Oncology Drugs & Biologics

Oncology care has evolved within the past few decades. Therapies have emerged which target specific mutations in tumor cells and interfere with cellular processes known to cause cancer. These "targeted" therapies are used in combination with conventional chemotherapy to treat patients with cancer; and, in some cases, they are considered the standard of care. Because therapies are being tailored towards the patient's specific cancer-causing mutation, cancer care has become more personalized. However, before clinicians can prescribe these therapies, the specific mutations targeted by these agents should be confirmed through molecular, diagnostic tests. For this reason, a number of the targeted therapies approved by U.S. Food and Drug Administration (FDA) require companion diagnostic tests.

To gain a better understanding of companion diagnostic testing and targeted therapies, the National Comprehensive Cancer Network® (NCCN®) conducted an NCCN Trends™ Survey in March 2012. Respondents included oncology physicians, nurses, surgeons, pharmacists, and other oncology stakeholders from the United States and abroad. The survey focused on understanding the frequency of companion diagnostic testing and the perceived impacts of targeted therapies on the future of chemotherapy use.

To understand the frequency of companion diagnostic testing, we asked how often companion diagnostic testing was performed. According to the results, only 16 percent of the respondents answered "Always," with 55 percent answering  "Often" to "Sometimes," and 29 percent answering "Rarely" to "Never" (Figure 1, n=857).

Respondents were also asked their thoughts on how the availability of newer, targeted therapies will affect the use of chemotherapy within the next five years. According to the results, 38 percent thought the use of chemotherapy agents to treat patients with cancer will decrease; 30 percent thought use will stay the same, and 32 percent thought use will increase (Figure 2, n=866).

In summary, oncology stakeholders held different perceptions of how targeted therapies will affect the utilization of chemotherapy in the future.  As for companion diagnostic testing, the survey results demonstrate that challenges still remain in the integration of molecular testing. Only 16 percent of the respondents claim to "Always" perform companion diagnostic testing when treating patients with targeted therapies, versus 29 percent who claim to "Rarely" to "Never" perform these tests.

Because of the importance of molecular testing, NCCN held a policy summit in July 2011 titled, NCCN Oncology Policy Summit: Molecular Testing - Effectiveness, Efficiency, and Reimbursement. This policy summit culminated in the white paper titled, "NCCN Molecular Testing White Paper: Effectiveness, Efficiency, and Reimbursement," which was published as a JNCCN – Journal of the National Comprehensive Cancer Network supplement in September 2011.

In the spring of 2013, NCCN will re-visit this important topic in an invitation-only policy summit. The Summit will assess the current status of molecular testing and aim to review the newest guidance documents and regulatory requirements, examine payer viewpoints and practices, and discuss the future of such tests. The Summit will bring together patients, providers, policy-makers, industry, payers, government, and other stakeholders for an in-depth discussion about this important element of cancer care.

NCCN Trends™ is a survey-based analytics tool from NCCN that focuses on how clinicians in the United States and abroad deliver cancer care. NCCN Trends™ Surveys pose questions regarding topics including, but not limited to, patterns of care, and awareness and utilization of various treatment modalities, as well as key topics impacting oncology stakeholders.

Data is gathered through brief electronic surveys to more than 200,000 health care providers who access the NCCN website on a frequent basis and express interest in responding to NCCN Trends™ Surveys. These clinicians consist of practicing physicians in diverse practice settings, including academic/research cancer centers, community hospitals, and private practices. Survey participants also include pharmacists, nurses, and other oncology stakeholders.

To learn more about NCCN Trends™ Surveys and Data, to commission a survey, or to discuss a customized survey, please contact Jake Guinto, PhD, Manager, Oncology Drugs & Biologics.