Tuesday, September 11, 2018

News Watch: Genomeweb Article on Oregon's Position on Oncology Gene Panel Tests

For those with a Genomeweb subscription, see Turna Ray's deep-dive story on responses from cancer groups to an Oregon policy statement against coverage of somatic mutation gene panel tests in cancer.

The September 11, 2018, Genomeweb article is online here

In brief, the Oregon Health Evidence Review Commission has a busy rolling schedule of policy meetings (calendar here).   Health tech assessment meetings are here.   The June 28 meeting assessed single fraction radiotherapy for palliative care and then assessed "FDA approved next generation sequencing tests."
  • See Agenda here
  • Evidence review materials here (NGS at page 32ff),*
  • Minutes here (minutes on Foundation One are just a few sentences).    
The Genomeweb article discusses the role of OHSU's Vijay Prasad, a noted commentator on evidence for precision medicine.  The responses of various cancer groups are discussed.

According to Genomeweb, one of the issues discussed by stakeholders is the pan-cancer coverage under the NCD and the question of who will be tested under a potential Oregon Medicaid program.   One stakeholder notes the differences in approved drugs for lung vs prostate cancer and said the difference was "apples and oranges." 

Data is publicly available for the distribution of recent tumor types in the tissue archives used for FMI and MSKCC IMPACT test authorizations.   I summarize these below.  MSK reported 17 tissue types, 10,554 blocks, of which the top 5 (58%) were lung, breast, colorectal, prostate, and glioma.  FMI reported 38 tissue types, 80,715 blocks, of which the top 5 (58%) were lung, liver, lymph node, brain, and colon.   Prostate, for example, was 8% of MSK cases and 2% of FMI cases.**  Alternately, prostate volume at MSK was 44% of lung volume, but at FMI, prostate volume was 9% of lung volume.

click to enlarge


Oregon also hosted the OHSU Evidence Based Practice Center, which is supported as part of the national network of practice centers that contract to organizations like USPSTF and AHRQ.

For a negative article on precision medicine in New York Times, appearing the same day as this Genomeweb article, here.

* Page 6 of this document discusses recent review of Oncotype Dx and a "weak" recommendation for coverage in breast cancer patients with 1-3 nodes.

** For 5 tumors found in both top-ten lists, by percent of that lab's cases, the correlation between the FMI and MSK percentages was r = 0.7.

2017 FMI 1130 FDA P170019B Tumor Types b.xlsx