Navigating Risk, Treatment, and Reimbursement in Precision Oncology: Sadie Dobrozsi, MD

Precision medicine has long shaped cancer care by tailoring treatment to the molecular profile of a patient’s tumor. But Sadie Dobrozsi, MD, medical director for genetic testing and oncology imaging at Evolent, says predictive genomics goes deeper, integrating a patient’s genetic makeup, family history, environment, and overall health to guide both risk reduction and treatment decisions.

Dobrozsi explains how predictive genomics identifies individuals with inherited mutations, such as BRCA1/2, that increase cancer risk. This enables personalized risk-reduction strategies, ranging from enhanced screening, like breast MRI, to preventive surgery. While payer coverage for germline testing and screening has improved, coverage for more invasive interventions still varies.

Predictive genomics also shapes treatment planning, not only identifying which therapies may work but also who might avoid unnecessary toxicity. Genomic signatures in tumors can determine the need for chemotherapy in early-stage breast cancer or guide the use of targeted agents like PARP inhibitors in BRCA-mutated tumors.

An emerging area, pharmacogenomics, may further refine treatment by revealing how individuals metabolize drugs, helping avoid ineffective dosing or severe adverse effects. However, Dobrozsi explains the field faces barriers, including data overload, ancestry bias in genetic databases, and inconsistent insurance reimbursement, especially for newer tools like circulating tumor DNA tests.

Evolent plays a key role by aligning clinical evidence with payer policy. Dobrozsi says her team evaluates test quality and relevance, helping health plans streamline access to the most clinically meaningful diagnostics.

As predictive genomics evolves, the goal is clear: “right-sizing” cancer therapy for each individual, using evidence to improve outcomes while minimizing harm.

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