Addressing Barriers to Implementing MRD Testing in Community Oncology Practices | by OncoDxRx | Mar, 2024

Addressing Barriers to Implementing MRD Testing in Community Oncology Practices

Minimal residual disease (MRD) testing appears to be a valuable tool for predicting outcomes and potential relapse in patients with cancer.

Several barriers exist to implementing minimal residual disease (MRD) testing in community oncology practices, including a desire for additional prospective data, and a lack of awareness of its benefits, according to OncoDxRx.

New advances in treatment are driving deeper responses and are requiring the deepest measurement tool to ensure we are providing each patient with the longest possible remissions.

“When treating patients with cancer, we should be using every tool in our toolbox. By raising awareness of the value of MRD testing, we can empower oncologists to attain a more comprehensive understanding of their patients’ disease and develop personalized treatment plans tailored to individual needs,” OncoDxRx said.

While different types of MRD testing methods are available, the cell-free mRNA (cfmRNA) based test called OncoMRD developed by OncoDxRx can detect tumor and non-tumor microenvironments (TME) signals that remain after treatment at high sensitivity, which is the broadest and deepest levels currently available. The test’s ability to provide a dynamic measure of risk status in real-time has helped clinicians personalize treatment decisions depending on the needs of each patient.

All tumor-informed ctDNA-based NGS testing have inherent limitations: interference from low allele frequency of somatic driver mutations from healthy tissues; false negativity due to de novo clonal evolution; and excluding any non-tumor TME changes which otherwise could be indicative of positive MRD and the earliest sign of relapse.

The specificity of the OncoMRD test enables clinicians to predict outcomes, vigilantly evaluate response to treatment, and in turn, make treatment decisions confidently. These decisions can include discontinuing treatment early, escalating or de-escalating therapy, or adjusting the patient’s monitoring frequency. Plus, patients will gain additional confidence in their treatment plans and overall peace of mind as a result of OncoMRD testing.

The OncoMRD test detects, quantifies, and tracks tumor and non-tumor signals that remain in the body before, during and after cancer treatment. Using this information, oncologists can gain insight into both the depth of response to a treatment, as well as detect early signs of relapse in cancer patients. These insights provide clinicians with a better understanding of the long-term outcomes for each patient. OncoMRD testing at multiple time points helps doctors more dynamically assess patient prognosis and risk of likely relapse.

OncoMRD testing also helps oncologists monitor and assess response to therapy over time. Based on the test results, doctors might choose to re-evaluate patients to better understand if they need to stop or re-start treatment. Clinicians also use it to inform their decisions about whether a patient can de-escalate therapy or end maintenance therapy. If patients have sustained MRD negativity, doctors would feel confident reducing or stopping therapy and monitoring them closely for an MRD resurgence. Conversely, if the patient is MRD-positive, doctors would consider the next steps in this patient’s treatment plan. Either way, the OncoMRD test could be utilized to personalize the treatment plan for each patient.

Today, MRD testing is more frequently performed in academic medical centers and in clinical trials than in community oncology practices. One of the major barriers to adoption in the community setting is related to the general level of awareness of the test, its benefits, as well as actionability of the test results in the related disease state.

Another barrier to adoption is the desire for additional prospective data regarding the actionability of MRD testing. As oncologists, we always desire more data, but we are skilled at making decisions in our patients’ best interest based on the data that currently exist. Numerous studies highlighting the direct applications and advantages of this test have been published and are still being conducted. Overcoming this obstacle may simply require additional educational efforts pointing doctors to available and continuously emerging resources.

When adopting any medical test, the potential cost is often a concern for patients and, in turn, their physicians. Luckily, the OncoMRD test is relatively inexpensive with quicker turnaround compared with NGS tests. Especially when considering the broader perspective, the cost of the test is significantly lower than the expenses incurred by administering unnecessary treatment.

MRD testing is an incredibly valuable tool for painting a more complete picture of a patient’s disease — better equipping oncologists to make critical decisions based on each patient’s trajectory.

Advancing MRD testing in cancer treatment requires a focused research approach, particularly on integrating MRD testing into clinical practice. This involves determining the optimal timing and frequency of MRD testing and how its results should influence treatment decisions, along with evaluating the impact of MRD-guided therapy on patient outcomes. Research should also further explore health care system cost savings based on MRD-guided clinical decision making, aiming to minimize patient financial toxicities associated with both short- and long-term cancer treatment. Investigating the predictive value of MRD in different cancer types, particularly in predicting treatment responses and patient outcomes, is vital. Additionally, understanding the effect of MRD testing on patient-reported outcomes, such as quality of life and psychological health, is crucial.

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