Genomic tests for cancer split oncologists

Some of India’s leading oncologists have raised doubts over the utility of the tests like Oncotype DX genomic test, which assesses how a cancer is likely to respond to treatment, saying it increases the cost of treatment without yielding clear benefits while others have expressed their support. 

In June several oncologists at the American Society of Clinical Oncology had validated the test that many experts claim can be used by women suffering from early-stage breast cancer to forgo chememotherapy offering relief to several patients suffering from the toxic side effects of chemotherapy. 

The test is offered by the United States-based genomic firm OncotypeIQ, which conducted a study, TailoreX, and reported that women who are diagnosed early with breast cancer and with a mid-range tumour score of 21 can skip chemotherapy. It said that the study found no improvement in disease-free survival when chemotherapy was added to hormone therapy in the group of trial patients. 

However Dr Sudeep Gupta, medical oncologist at Mumbai’s Tata Medical College, told ET that even without the Oncotype DX test oncologists in India did not put patients under chemotherapy. “These tests might not add much value, and they are possibly not needed when good pathologists are available in hospitals,” he said. “The bulk of the patients are not eligible for these tests. When I get 100 patients in my OPD, 10-15 patients might fall in low-risk category and those patients are anyway not put under chemotherapy by us.”

Therefore, he said, while in the US such a test is conducted for $500 (about Rs 34,000) to determine whether a patient needs chemotherapy, in India a good pathologist can offer a similar service for $20 (about Rs 1,360). 

In the past decade several gene testing firms have emerged in Europe and India as well that are looking at ways to improve diagnosis and treatment of cancer. Gene testing diagnosis has become a core part of personalised medicine as medical practitioners are looking at ways to improve diagnosis and treatment of cancer. Gene testing diagnosis has become a core part of personalised medicine as medical practitioners are looking at ways to prescribe treatments according to individual needs. Like the Oncotype DX test, there are several other tests such as Mammo Print, Endo Predict and PAM 50 which study the association of a specific gene with different levels of low, medium or high risk for recurrence in a breast cancer patient. 

In India startups such as Medgenome, Strand Lifesciences and Xcode Lifesciences are working to bring these tests to India. These firms have generated significant interest from private equity investors who have together invested close to $100 million. The reluctance of oncologists in India to endorse these tests has casts doubts over the commercial viability of such startups. 

Dr V Shanta of The Cancer Institute said that gene testing is being taken up by a large number of companies not just as part of healthcare but also business enterprise and thus there are significant ethical issues for consideration. “Unfortunately, the medical professional does not consider itself responsible for reducing the cost of treatment. All available tests are expensive,” he said. 

In an editorial in its June issue, scientific magazine Nature wrote about financial toxicity of cancer and said that certain studies had shown that current therapies and treatments added little value to patients’ lives.

Another reason for the scepticism over such tests is that 50-60% cases fall in intermediate risk category and the tests cannot conclusively determine whether these patients should undergo chemotherapy. 

Dr Shanta said that although genetic testing is an upcoming concept and will ultimately become a routine part of clinical care, it still has a long way to go and that cost is an important factor. Besides, she said, “The WHO does not recommend it at present.” 

Cost is not the only factor, according to other physicians, who said that a key parameter should be whether such tests make the decision-making process of oncologists easier. 

Dr Sachin Almela of Mumbai’s Hinduja Hospital, however, backed the efficacy of the Oncotype DX test. “Affordability is the only reason why I won’t prescribe the test, but clinically the test has merits. Now we have a mathematical number that we can put instead of depending on a pathologist where there can be human error,” he said. “The pathology report was not more objective; it was more of person’s clinical acumen. So there are loopholes there.” 

VL Ramaprasad, chief operating officer of MedGenome, a gene diagnostic startup, said that the Oncotype DX test had entered the market after several rigorous regulatory approvals and that it would be incorrect to write it off as one that did not add value. 


Biocon managing director Kiran Mazumdar-Shaw, has invested in her personal capacity in several cancer diagnostic firms, said she felt that in India doctors were not doing enough evidence-based practice and their reluctance to accept new technology was hindering progress. “We have to embrace new tech, correct diagnosis, and cancer is one disease that has to have personalised treatment,” she said. 

Source:https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/genomic-tests-for-cancer-split-oncologists/articleshow/64756787.cms