Dr. Pranil Chandra and Dr. Luis Raez: Enabling Comprehensive Genomic Profiling in Lung Cancer
In this episode of the Precision Medicine Podcast, hosts Karan Cushman and Clynt Taylor welcome back Dr. Luis Raez, Medical Director and Chief Scientific Officer at Memorial Cancer Institute, who is joined by Dr. Pranil Chandra, Chief Genomics Officer at PathGroup. Together, we discuss the key barriers to performing comprehensive genomic profiling for cancer patients and how collaboration between oncologists and pathologists can enable a more consistent approach.
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Both doctors have seen remarkable advances in the identification of driver mutations and related targeted immunotherapies in precision oncology, and yet they also recognize a persistent lag in biomarker adoption and appropriate testing.
To demonstrate this reality, Karan references the 2022 MYLUNG retrospective observational study that investigated metastatic, non-small cell lung cancer patients receiving first-line systemic therapy within a large community oncology network. The study, which occurred between April of 2018 and March of 2020, found that while most patients were tested for one biomarker, only 46% were tested for all five of the guideline-recommended markers, which include PD-L1, EGFR, ALK, ROS1 and BRAF. This was also true for next-generation sequencing.
Dr. Raez and Dr. Chandra point to several reasons for the lack of testing, including the complexity of new innovations for oncologists and healthcare disparities, and they explain some of the improvements that should be made to help close the gap between available life-extending, targeted therapies on the market today and the lung cancer patients who need them. These include:
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Better coordination and collaborative communication between pathologists and oncologists to ensure the appropriate molecular tests are ordered in a timely manner. Often, they point out, the oncologist is waiting for the pathologist to order the test, and any delays can add stress for patients who are anxious for results.
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Using liquid biopsy when there is not enough high-quality tissue to make a diagnosis and perform ancillary molecular testing. (Dr. Chandra notes that you need at least two to four millimeters of tissue with at least 20% tumor.)
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Ensuring lab reports are easily and accurately interpreted and therefore more actionable.
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Constructing faster and more flexible approaches to regulation and reimbursement.
Both doctors speak in-depth about the importance of a coordinated, multidisciplinary, institutional approach to implementing comprehensive genomic profiling, which is the standard of care in patients with advanced non-small cell lung cancer. It’s a valuable episode for anyone concerned with how slowly molecular testing is being adopted when the benefits to cancer patients are clear.
Download the full transcript of the episode here (pdf).
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About Our Guests
Pranil Chandra, DO, FCAP, FASCP
Senior Vice President and Chief Genomics Officer, PathGroup
Dr. Chandra currently serves as Senior Vice President and Chief Genomics Officer at PathGroup and provides enterprise-wide leadership to molecular testing and cancer diagnostics. Dr. Chandra joined PathGroup in 2011 as Associate Medical Director of Molecular Pathology and served as Medical Director and AVP of Molecular Pathology from 2013-2016, and Vice President and Chief Medical Officer of Genomic and Clinical Pathology services from 2016 to 2021. Dr. Chandra holds board certifications in anatomic and clinical pathology, hematopathology and molecular genetic pathology. He completed his AP/CP training and fellowships in hematopathology, oncologic pathology and molecular pathology at NYU Langone Medical Center and the University of Texas-MD Anderson Cancer Center, respectively. While at MD Anderson, he served as Chief Fellow and received numerous awards for his research in acute myeloid leukemia. He has presented numerous abstracts and platform presentations at various pathology meetings and has published peer-reviewed articles and book chapters. Dr. Chandra is a member of the American Society of Clinical Pathology, College of American Pathologists, and Association of Molecular Pathology where he also serves in a leadership capacity to the Economic Affairs Committee as Vice-Chair of Coverage. He also serves as senior adviser to CMS on matters related to laboratory testing pricing and coverage. As such, Dr. Chandra is a recognized medical consultant in molecular pathology and personalized medicine and is considered a national thought leader in Precision Diagnostics and Cancer Genomics.
Luis E. Raez, MD, FACP, FCCP
Medical Director of Memorial Cancer Institute (MCI), Oncology Research Director of Memorial Health Care System (MHS), and Director of the Thoracic Oncology Program
As well as being the Clinical Associate Professor of Medicine at Florida International University (FIU) and Visiting Professor of Medicine at Cayetano Heredia University in Peru, Dr. Raez currently designs phase I-III clinical trials with new chemotherapeutic agents and combinations. Dr. Raez does translational research in the areas of cancer vaccines and has been funded by NCI and the pharma industry. Dr. Raez has given oral presentations and lectures in national and international meetings in the U.S., Europe, Latin-American, and Asia. He is American Board Certified in: Internal Medicine, Medical Oncology and Geriatric Medicine. He is board eligible in Hematology. Dr. Raez is a member of AACR, ESMO, ASCO, IASLC, ALLIANCE, NCCTG, ACCP, ACP, ACSG, and FLASCO among other institutions.