Episode 437: Precision Oncology: What We’ve Learned and What’s Ahead

“Biomarker testing isn’t just about generating more information. It’s about answering very practical questions for our patients. Can we identify disease earlier? Can we understand whether treatment is working? Are we able to identify why a cancer has become resistant? Ultimately, I think that’s where precision oncology becomes very meaningful. It’s not about the molecular report sitting in the chart. It’s about taking that information and using it to make the best possible decision for our individual patients,” ONS member Erica Bello Rodriguez, MSN, AGNP, NP-C, AOCNP^®, oncology nurse practitioner and supervisor of advanced practice providers at Northwell Health Cancer Institute in Westchester, NY, told Katie Hubbard, MSN, RN, OCN^®, NPD-BC, oncology clinical specialist at ONS, during a conversation about precision oncology.

This podcast episode was produced by ONS and is sponsored by AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Episode Notes 

• This episode is not eligible for NCPD contact hours.
• ONS Podcast™ episodes:
  • Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices
  • Episode 238: Cancer Genomics for Every Oncology Nurse
  • Episode 226: Patient Education for Next-Generation Sequencing to Guide Cancer Therapy
  • Episode 169: How Biomarker Testing Drives the Use of Targeted Therapies
• ONS Voice articles:
  • An Oncology Nurse’s Guide to Tumor-Agnostic Therapies
  • Gene Alterations in Circulating Tumor DNA Can Help Guide Treatment Decisions in Patients With Advanced Breast Cancer
  • Genetic Counselors Help Patients and Oncology Nurses Predict Current and Future Cancer Diagnoses
  • Germline and Somatic Variants: What Is the Difference?
  • Learn How to Read a Germline Genomic Testing Report
  • Learn How to Read a Somatic Biomarker Testing Report
  • Oncology Nurses’ Role in Translating Biomarker Testing Results
  • Pharmacogenomics Testing Helps to Ensure That Effective Therapy Is Safe Therapy
  • The Oncology Nurse’s Role in Identifying Patients for Cancer Genetics Counseling
  • What Is a Liquid Biopsy?
• ONS book: Understanding Genomic and Hereditary Cancer Risk: A Handbook for Oncology Nurses
• Clinical Journal of Oncology Nursing articles:
  • Pharmacogenomic Germline Testing: Applications in Oncology Nursing
  • Oncology Nurse Practitioners in Genetics: Examining Scope of Practice and Competence
  • Shifting to a Biomarker Paradigm Across Cancer Care
  • Using a Genomics Taxonomy: Facilitating Patient Care Safety and Quality in the Era of Precision Oncology
• ONS Huddle Cards:
  • Genomic Biomarkers
  • Genomic Testing Methods
  • Pharmacogenomics
  • Referring for Germline Biomarker Testing
• ONS Biomarker Guides
• ONS Genomics and Precision Oncology Learning Library
• ONS Genomics Taxonomy
• American Cancer Society: Precision or Personalized Medicine
• American Society of Clinical Oncology Publications: JCO Precision Oncology
• National Cancer Institute: Cancer Genomics Research

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“Some of the most important developments since 2020 have really been broader than any single variant or drug. We’ve seen precision oncology evolve from simply identifying a genomic alteration to developing a much more comprehensive understanding of what is driving an individual’s cancer and how we can act on that information. One major development has been the expansion and accessibility of comprehensive biomarker testing and next-generation sequencing. We’re able to identify more of the molecular characteristics of a tumor, and those findings can increasingly help inform treatment decisions and clinical trial opportunities for our patients. We’ve also seen the continued evolution of tumor agnostic therapy, which represents a really important shift in how we think about cancer treatment.” TS 3:52

“Nurses have become increasingly important as a translator and advocate. Genomic reports are incredibly complex, and patients don’t necessarily understand terms such as ‘pathogenic variant,’ ‘actionable biomarker,’ or ‘tumor agnostic therapy.’ Nurses are often the people who have meaningful relationships with the patients, and they have to take that complex science, simplify it, and highlight it for them. ... The science is becoming more precise but the need for a nurse to make that science understandable and patient-centered is becoming even greater.” TS 7:12

“I’m really excited about circulating tumor DNA, or ctDNA. For example, I think about a patient with stage III colon cancer who has completed treatment with curative intent. Her scans may look completely clear and clinically, she looks great, but we’re beginning to use ctDNA to look for molecular residual disease. Essentially, we’re trying to determine whether there may be microscopic disease present that we just can’t see on imaging yet. For that patient, a positive ctDNA result could tell us that there may still be disease at a molecular level, even though the computed tomography (CT) scan looks normal to us. It also has the potential to help us monitor disease over time, understand treatment response, and identify emerging resistance. I think that’s really exciting because historically, we thought about biomarkers more as a snapshot. With ctDNA, we’re beginning to think about biomarkers as something we can follow longitudinally. I think it’s important to acknowledge that we’re still learning exactly when ctDNA results should change treatment, but the potential is enormous.” TS 9:09

“We have incredible biomarker-driven treatments, but not every patient has equal access to comprehensive testing, genetic counseling, clinical trials, or the therapies a biomarker may identify. Access can vary based on geography, insurance coverage, the healthcare system, and many other external factors. So one of the challenges is making sure that precision oncology doesn’t become something that’s only available to patients who have the resources to navigate the system. We really need to work on helping those that don’t have as much access.” TS 18:14

“If I had to summarize where I think we’re headed, I would say we’re moving from precision oncology being a snapshot of a patient’s cancer to something much more longitudinal. ... We’re going to be better at understanding what’s driving the cancer, how it’s changing, how it’s responding, and hopefully intervening earlier and more precisely. Ultimately, I think the goal is to not just give more information, but to provide better decisions and better outcomes for our patients.” TS 24:36