Examining the Promise of Multicancer Early Detection Tests: Looking to the Future

In this seventh episode of OncChats: Examining the Promise of Multicancer Early Detection Tests, Toufic A. Kachaamy, MD, Madappa Kundranda, MD, PhD, and Niloy Jewel J. Samadder, MD, discuss the data that are still needed to inform optimal utilization of multicancer early detection (MCED) tests and their potential cost effectiveness.

Kachaamy: While we are waiting for the randomized control trials [RCTs] to come out, what do you feel are the other big holes that need to be filled prior to us recommending this type of testing more broadly? We’ll wait for the RCTs, but in the interim, what else do you think we need to see in terms of data?

Samadder: Seeing these newer, cross-sectional [kinds of] studies or short-term prospective studies and having them peer reviewed and published right now [would be helpful]. Most of these data are only being shown in abstract form at national meetings. And so, can we see peer-reviewed data in a journal where we have access to all the data elements, including stage shifting, precancerous lesions identified, [and] the amount of diagnostic workup required— [ie] fully vetted data? I think that would give us some comfort, at least [regarding] the clinical use of the product today, while we’re waiting for the RCTs. Number two is the ability for the industry, academic, and large community centers to set up pragmatic institutional review boards [IRBs] to enroll patients who are getting clinical testing outside of a trial, whether that is industry- or National Institute of Health–funded trials. [Placing them] in IRB [is needed] so that they can be followed [and they] know [that] they are essentially adding to the data that will be ultimately utilized.

Kachaamy: I know we’re almost out of time, but do I dare ask you about cost effectiveness? When you look at your crystal ball, do you think these tests will be cost effective—especially with the way we look at quality-of-life savings?

Samadder: This is a wonderful question to end on. That’s all to be determined but it is critical to understand [whether] this [approach] will really be cost effective. We’re only going to know that by doing the RCTs and having elements where we understand the amount of diagnostic workup that was needed for any positive signal and adding that into the stage shifting or the cancer mortality and quality-adjusted life years gained, to come up with a value of dollars per quality. Ultimately, that will guide insurance and government payers to say whether they would cover this, and for the US Preventive Services Task Force to include in their annual assessment of whether this type of product will have their clearance and recommendation.

Kachaamy: Thank you very much for taking the time [to discuss this today]. This is an extremely exciting time [where we are] combining genomics and AI [as we] look [toward] the future. Any final comments?

Samadder: Thank you for having me today. This is an exciting era that we live in, and we’re all going to need to look at our crystal balls to see what the future [holds].