Amid the explosion of new treatment options for cancer patients, the choice of when and how to choose a specific therapy is becoming increasingly complicated requiring input from multi-disciplinary teams.

Pathologists and laboratory professionals have long played an integral role in these teams. Beyond routine responsibilities, they also consult on new testing opportunities, interpretation of results and other matters that are critical to treatment decisions.

Now, as personalised healthcare increasingly moves to the forefront of oncology, the complexity of treatment decisions — and the role of the laboratory in driving them — is likely to grow.

As advances in precision medicine bring life-saving therapies to cancer patients across the Asia Pacific region, pathologists and other laboratory professionals have new opportunities to shape treatment decisions. In an interview with Dia:gram, laboratory leaders discuss the growing role of pathology and the clinical laboratory in the era of precision oncology.

The Rise of Precision Diagnostics 

Precision oncology is an emerging paradigm of care that targets treatments to the unique attributes of narrow patient subpopulations. It requires careful review of detailed genotypic and phenotypic data, as well as knowledge of the latest research outcomes or clinical trials, to match patients to existing or potential therapeutic options.

In this scenario, laboratory diagnostics are even more critical to generating the data necessary for selecting those therapies. From companion diagnostics to new diagnostic methods like liquid biopsy that provide non-invasive approaches to treatment selection and disease progression monitoring, diagnostics are fast becoming the backbone of any precision oncology plan.

As the burden of cancer grows, demand for these diagnostics is growing across Asia. Some countries are also making efforts to develop the regulatory frameworks to ensure these tests are accessible to patients.

“Many tests — including those for PDL1, EGFR, and ALK — are being used as companion diagnostic tests for non-small cell lung cancer in Korea,” notes Dr Junghan Song, Vice President and Chief Medical Officer at Seoul National University Bundang Hospital (SNUBH). He says the hospital recently established a Clinical Precision Medicine Centre that pulls together multi-disciplinary teams to ensure those tests are applied effectively.

Even in emerging countries, which face a shortage of oncology professionals, access to precision diagnostics is increasing. Indonesia, which rolled out its ambitious Universal Healthcare Program, has seen an upward trend.

“Test volumes are growing due to improving insurance coverage, better awareness among clinicians and an expanding evidence base that such tests are locally suitable and meaningfully impacting survival,” explains Dr Agus Susanto Kosasih, an expert in haematological malignancies who heads the Clinical Pathology medical staff at Dharmais Cancer Hospital, a national centre based in Jakarta.

“We still face challenges, but the general direction is positive.”

The Tipping Point for Clinical Laboratories

With diagnostic technology getting more complex every year, it will become increasingly challenging healthcare providers to keep abreast of the new tests that are coming into clinical practice. In such an environment, laboratories have an important responsibility to stay on top of the latest technologies and guidelines, and contribute proactively to discussions around test selection and the interpretation of results.

With the rise of precision medicine, the most forward-thinking laboratories are not only participating in the multi-disciplinary teams that make key treatment decisions, but also looking beyond traditional parameters — which revolve around quality, speed and cost — and gathering data to determine how diagnostics actually impact patient outcomes.