Tumor sequencing takes off, but insurance reimbursement lags

Shraddha Chakradhar

Nature Medicine

20,

1220–1221

(2014)

doi:10.1038/nm1114-1220

Published online: 06 November 2014

Meghan O'Brien was diagnosed with stage 4 lung cancer in 2012 at the age of 30. Neither the most aggressive form of radiation therapy nor a drastic spinal surgery to eliminate the tumors in her spine did anything to help with her advanced cancer. Only when she was referred to Ravi Salgia, director of the thoracic oncology program at the University of Chicago School of Medicine, did she begin to find concrete answers to why her cancer wasn't responding to standard therapy and other avenues she could explore.

Salgia's primary focus is lung cancer, which has many subtypes. And knowing the particular kind of lung cancer is key to finding the right treatment. The solution for many medical oncologists like Salgia is tumor sequencing. Sequencing even a small piece of the tumor can reveal many more things about the nature of the cancer than a simple biopsy alone. In O'Brien's case, genetic testing of her tumor revealed that she had a mutation in the anaplastic lymphoma kinase, or ALK, gene.

“We were able to find the particular translocation in the ALK gene when we sequenced her tumor, and [we] started her on an ALK-inhibiting drug regimen,” Salgia says. When this drug stopped working, O'Brien was referred to a clinical trial where she was prescribed a different ALK inhibitor. Now, although her cancer hasn't gone away, her condition is currently stable.