Observations on Oncology Biomarker Testing

Post By Molly Simpson

InCrowd recently conducted a survey to better understand how oncologists learn about targeted biomarker tests and what resources would be helpful for biomarker testing awareness. The data was collected from 100 US oncologists through an InCrowd MicroSurvey between April 15th – 21st, 2021 and provided insights into what the future of biomarker testing could look like. 

Biomarkers are molecules that show typical or atypical processes in the body and can often identify signs of an underlying condition. Oncology biomarkers are produced by cancerous tissue or by other cells as a response to cancer. Biomarkers can be found in tumor tissue, blood, stool, urine, and other tissues or bodily fluids. There are several different types of biomarkers, such as proteins, gene mutations, gene rearrangements, extra copies of genes, missing genes, and other molecules found in the body. There have been numerous milestones throughout history that have furthered the research surrounding oncology biomarkers. Many of them include the identification of biomarkers that are directly linked to specific cancers. As of 2018, more than half of the clinical trials conducted in the US use biomarker testing.  

Following a cancer diagnosis, 93% of respondents report ordering the initial set of biomarker tests. While around 56% report ordering non-standard tests at diagnosis, 61% reported ordering additional non-standard tests after 1L treatment failure. When asked how respondents prepare their patients for disappointment from targeted testing results since certain treatments are only available to those with certain biomarkers, respondents mention trying to be as upfront as possible. For example, an oncologist in Maryland said, “I let them know that the chances are low that they will have a targetable mutation, so they don’t get their hopes up unreasonably high. However, it is impossible (and not advisable) for them NOT to get their hopes up.” 

Currently, only 38% of tests being ordered by oncologists are targeted. A large barrier to targeted testing is insurance coverage and out-of-pocket costs. Several respondents also report that these tests are invasive and worry they take extra time. Respondents mentioned that they primarily learn about these new targeted tests from peer-reviewed journal articles and conference presentations. Only a quarter said they learn about them from pharmaceutical sales reps.  

When asked what would motivate respondents to order more targeted testing, 42% noted evidence and data. Additionally, pharma companies with strong communication regarding required biomarker testing for their product have a robust marketing, education, and data publishing approach. One oncologist shared that, “they update us regularly regarding new options and costs, which allows us to incorporate these tests rapidly into practice for appropriate patients.”  This transparency is critical for motivating oncologists to order targeted tests that might be costly to the patient but hopefully help identify the most effective treatment. 

InCrowd used both qualitative and quantitative methods to gather data from oncologists across the US. One hundred oncologists were surveyed, in addition to two oncologists who participated in in-depth interviews and provided additional insights into these findings. Screening criteria required respondents to be treating at least 50 cancer patients in a typical month and order at least 20 biomarker tests for their patients per month. For more detail, please see our report. 

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