Dr Elizabeth Griffiths Discusses Barriers to Genetic Testing in AML

The biggest barrier to molecular profile testing right now is a financial one, explained Elizabeth Griffiths, MD, associate professor of oncology, department of medicine, Roswell Park Comprehensive Cancer Center.

TranscriptWhat barriers still remain in knowing how and when to test for genetic mutations and deciding which treatment is best for a patient?

I think the biggest barrier right now is a financial one. Many insurance companies still deny approval for molecular profiles. While they will approve specific mutational events, they won’t approve the profile. I think that’s shortsighted. I think that as these profiles become less expensive, and as we learn about the importance of mutational events over and above the initial 6 or 10 mutational events that are now recognized, we’re going to earn more about acute myeloid leukemia, and we’re going to learn more about how to effectively treat these patients.

Mutational events can help to delineate minimal residual disease, as well. So, if you have a mutational profile at the time of diagnosis, you can use those identified molecular events at the time of remission to determine the depth of that remission. And you can make decisions, potentially, although not yet proven, you can at some point in the future, you might be able to make decisions about what therapy to give next, especially with respect to allogeneic transplant or intensification of therapy or capitalizing on some of these targeted therapeutics to drive deeper remissions and thereby get better long-term outcomes for patients.

I think these molecular profiles help us to think about patients. I think if you have a patient with 6 or 9 mutational events, that patient is overall less likely to do well than a patient who has less events. And Elli Papaemmanuil, PhD, assistant attending computational oncologist, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, has shown that in her original paper in 2016 published in the New England Journal of Medicine.

I think that approach with casting a broader net and capturing the mutational events that characterize leukemia is likely to help us in the long-term manage patients more effectively.