OnCo
ideasIdea

Pathologists order genomic profiling automatically at diagnosis of advanced cancer

Many patients with advanced lung or bowel cancer start treatment without the gene tests that would show whether a targeted drug would work. Let the pathologist order the full test the moment cancer is confirmed, without waiting for an oncologist.

Real-world data show that a substantial fraction of patients with advanced NSCLC begin first-line therapy before biomarker results are available or without full testing, forgoing targeted therapy. Reflex testing, ordered by the pathologist at diagnosis on defined tumour types and stages, shortens time to result and increases completeness. Tissue stewardship, funding, and a default panel need agreement. Some regions have adopted reflex testing; most have not.

Hypothesis
Reflex comprehensive profiling will increase the proportion of advanced NSCLC and colorectal cancer patients with complete guideline biomarker results before first-line treatment from under 60% to above 90%, and increase targeted-therapy use in eligible patients.
Rationale
Reflex HER2 and ER testing in breast cancer is universal and uncontroversial; extending the same logic to genomic panels removes an avoidable coordination failure.
What would test it
A regional switch to reflex ordering with pre-post measurement of completeness, turnaround, targeted-therapy uptake, and tissue-exhaustion rates.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
2
Bottlenecks it attacks

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