Ensuring Coverage of Faster Biomarker Testing in Lung Cancer: Robert Kratzke, MD

Delays in molecular testing for patients with non–small cell lung cancer (NSCLC) can lead to treatment lags that cost lives, warned Robert Kratzke, MD, professor of medicine and head of medical oncology at the University of Minnesota.

In an interview with The American Journal of Managed Care®, Kratzke called for payer-provider alignment on reflexive biomarker testing, broader acceptance of real-world data, and a long-term view of value—even when only a subset of patients benefits. Kratzke joined other experts at a recent Institute for Value-Based Medicine® event to discuss advancements in precision medicine in lung cancer.

This transcript was lightly edited for clarity.

Robert Kratzke, MD | Image credit: M Health Fairview

AJMC: What were some of the common themes from your panel discussion?

Kratzke: Our panel had a great interest in testing biopsy samples for biomarkers that can benefit our patients—both genomic biomarkers, such as looking at the DNA sequence, or immunohistochemistry biomarkers such as PD-L1. The fact that this is not always reflexively done delays treatment for our patients, and we discussed how that was an impediment to care, particularly for patients in rural areas.

AJMC: How can payer-provider partnerships evolve to better support timely and comprehensive molecular testing in NSCLC for underserved populations?

Kratzke: For patient populations that either live in rural or underserved areas, it's critical that insurers insist there's rapid and quick access to biomarker testing in our biopsy samples. Efficient biomarker testing saves money and it saves lives both, and there's no particular reason why this shouldn't be done efficiently and quickly for all of our patients with lung cancer.

AJMC: What role should value-based reimbursement models play in determining coverage for high-cost immunotherapies or targeted agents in advanced NSCLC?

Kratzke: It is a reality that our patients’ biopsy samples be tested for markers such as PD-L1. They do guide our therapies per the NCCN [National Comprehensive Cancer Network] guidelines, and we appreciate that insurance providers want to follow those guidelines for our patients.

I do worry sometimes that the term value may include looking at outcomes where the benefit to a subset of our cancer patients can be profound, meaning lives up to 3, 4, or 5 years. Somebody could look at those data and say, “Yeah, but 60% to 70% of the patients do not seem to benefit.” I think any of us as human beings would say, “Well, there's a 1 out of 3 or 4 out of 10 chance that a biomarker-driven therapy would prolong our life by years.” The fact that the majority do not receive that benefit… I want insurance providers to see the value in long-term benefit, even for a minority of patients.

Not to be crude, but if something really benefits 20% of the patients, that may not seem all that valuable. But if you're in that 20% and living 5 years, it's very, very valuable, obviously. I think we learned valuable lessons from the breast cancer community decades ago. Drugs such as trastuzumab (Herceptin) are now commonly accepted as life-saving drugs, but when they were first tested, they helped really only a small subset of the patients until we figured out who they were.

AJMC: How can real-world data help justify coverage for new antibody-drug conjugates in NSCLC?

Kratzke: It's a little controversial, but in my opinion, real-world data are critical in allowing us to see who benefits and how much the benefit in longer lives or even lives saved can be.

In the academic community, sometimes there's some disdain about real-world data. But I think they can be very, very important and help guide our thinking and, once again, who may benefit the most, and frankly, what therapies may be more harmful than we originally thought, that many of the antibody-drug conjugates do have significant toxicities.