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

Expanded molecular or genetic panel testing has been proposed as a method to evaluate many genetic markers at a single time to identify chemotherapeutic agents that target specific pathways when the individual has failed to respond to standard therapy. This comprehensive genomic 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. There are a wide variety of commercially available expanded panel kits available. The following list contains 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. (11:2020). Comprehensive genomic profiling for selecting targeted cancer therapies (2.04.115). Retrieved June 11, 2021 from https://www.evidencepositioningsystem/. (32 articles and/or guidelines reviewed)

CMS.gov: Centers for Medicare & Medicaid Services. Palmetto GBA. (2020, March). Next generation sequencing for solid tumors. (LCD ID L38045). Retrieved June 11, 2021 from https://www.cms.gov.

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. (2021, March). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Non-small cell lung cancer V4.2021. Retrieved June 11, 2021 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:  8/12/2021

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