BlueCross BlueShield of Tennessee Medical Policy Manual

Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies

Does Not Apply to Commercial Genetic Testing Program effective 6/1/2018

DESCRIPTION

There is interest in treating cancers by targeting biologic pathways characterized by specific genetic markers. Some individual markers have established benefit in certain types of cancers; these markers are not addressed in this policy. Expanded molecular or genetic panel testing has been proposed as a method to evaluate a large number of genetic markers at a single time to identify chemotherapeutic agents that target specific pathways when the individual has failed to respond to standard therapy. Broad molecular profiling is recommended for individuals with non-small cell lung cancer to identify rare driver mutations to ensure these individuals receive the most appropriate treatment.

In addition to providing information on which targeted therapeutics might be appropriate, panel testing may also be useful in predicting resistance to certain drugs. There are a wide variety of commercially available expanded panel kits available. The following list contains some, but not all, examples of expanded genetic panels:

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES

American Society of Clinical Oncology. (2018). Molecular testing guideline for the selection of patients with lung cancer for treatment with targeted tyrosine kinase inhibitors: American Society of Clinical Oncology endorsement of the College of American Pathologists/International Association for the study of lung cancer/Association for Molecular pathology clinical practice guideline update. Retrieved December 11, 2018 from www.asco.org.

BlueCross BlueShield Association. Evidence Positioning System. (10:2018). Expanded molecular panel testing of cancers to identify targeted therapies (2.04.115). Retrieved December 11, 2018 from https://www.evidencepositioningsystem/.  (37 articles and/or guidelines reviewed)

Johnson, D., Dahlman, K., Knol, J., Puzanov, I., Means-Powell, J., et al. (2014) Enabling a genetically informed approach to cancer medicine: a retrospective evaluation of the impact of comprehensive tumor profiling using a targeted next-generation sequencing panel. The Oncologist, (19), 616-622. (Level 4 evidence)

National Comprehensive Cancer Network. (2018, November). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Non-small cell lung cancer V2.2019, Retrieved December 11, 2018 from the National Comprehensive Cancer Network.

Taylor-Weiner, A., Zack, T., O’Donnell, E., Guerriero, J., Bernard, B., Reddy, A., et al. (2016). Genomic evolution and chemoresistance in germ-cell tumours. Nature, 540 (7631), 114-118. (Level 4 evidence)

ORIGINAL EFFECTIVE DATE:  12/13/2014

MOST RECENT REVIEW DATE:  1/10/2019  

ID_BT

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