Dr Mulherin on Using AI to Address NGS Testing Barriers in Oncology Practice

“In advanced NSCLC, our NGS testing rates…were 89%. After [using our AI tool, which sends] a series of tips and insights, our rates have increased essentially to 100%. If we think of all the additional people who are going to [undergo the necessary testing because of this], that’s significant.”

Brian P. Mulherin, MD, an oncologist/hematologist at Hematology Oncology of Indiana, an affiliate of the American Oncology Network (AON), discussed how artificial intelligence (AI) might be leveraged to address insurance barriers and delays that limit timely patient access to next-generation sequencing (NGS) testing. 

Mulherin addressed the barriers that prevent timely patient access to NGS testing, specifically focusing on how AI might offer solutions. Mulherin stressed that all patients with metastatic disease, advanced solid tumors, or unacceptable stage III disease who are candidates for treatment should receive NGS. This necessity is supported by National Comprehensive Cancer Network guidelines and Medicare national coverage determination criteria for coverage, and AON has also adopted policies recommending this testing.

Despite these clear guidelines, NGS testing rates remain low. Although such rates are high in advanced non-small cell lung cancer (NSCLC), they are lower in areas like hormone receptor–positive breast cancer, where testing is crucial for identifying candidates for molecularly targeted therapy. Although tissue quality or availability can sometimes be an issue, Mulherin noted that liquid biopsies can help solve some of these concerns. He also highlighted the perception that insurance is a major barrier. However, Mulherin asserted that insurance should not be a barrier for 95% or more of people in the United States, as companies actively cooperate and will often write off the cost.

To address these low testing rates, MiBA has developed a series of insights called TIPS. These TIPS analyze data to identify patients who should be receiving NGS but are not, initially focusing on those with breast, lung, and colorectal cancers. If a patient is flagged as not having received NGS testing, a communication is generated. This communication is currently delivered via the Electronic Medical Record but can be customized for other platforms, such as HIPAA-compliant texts, emails, or hard copies, depending on the physician’s preferred workflow.

Mulherin provided evidence of the success of this system within AON. Real-world evaluation of AI notifications in patients with advanced NSCLC at AON showed that although NGS testing rates 7 months prior to the start of therapy were already high, at 87.34%, these rates increased to 99.41% in the 7 months following the first targeted education launch. Mulherin concluded that this increase in testing is significant, given the additional individuals who will now be tested and identified.

Disclosures: Mulherin disclosed employment, leadership, and ownership for American Oncology Network; honoraria from Daiichi Sankyo/Lilly, Caris Life Sciences, Jannsen Oncology, Kite/Gilead, Swedish Orphan Biovitrum, Incyte, TG Therapeutics, CTI BioPharma Corp, Alexion Pharmaceuticals, Apellis Pharmaceuticals, and Novartis; consulting or advisory roles for Apellis Pharmaceuticals, Novartis, Vertex, Pharmacosmos, BeiGene, and Meaningful Insight Biotech Analytics; speakers’ bureau fees from Apellis Pharmaceuticals; research funding from Apellis Pharmaceuticals, Pharmacyclics/Janssen, and Novartis (inst); and travel, accommodations, and expenses fees from Incyte, Apellis Pharmaceuticals, and Kite.