Best Practices

Barriers and Facilitators to the Use of Genomic-Based Targeted Therapy in the VA: Qualitative Findings

Reflexive testing, standardization of the mutation test ordering procedure and results reporting, and elimination of the preauthorization requirements could facilitate the utilization of targeted therapies.


Lung cancer is the most frequent cause of cancer-related mortality worldwide. 1 The most prevalent type of lung cancer is non-small cell lung cancer (NSCLC), which comprises about 85% of lung cancer cases. 2 As there are no cost-effective approaches to screening for lung cancer, most lung cancers are identified at an advanced stage (stage IIIB or IV).

New approaches to managing advanced lung cancer have emerged in recent years, including drugs designed to target specific genetic mutations in some tumors. 3 The National Comprehensive Cancer Network (NCCN) recommends erlotinib, a receptor tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR) for first-line treatment of advanced NSCLC with EGFR mutation. 4 Crizotinib is recommended to treat cancers that test positive for the anaplastic lymphoma kinase (ALK) mutation. 4 Utilization of targeting agents has been found to extend the survival times for patients with the specified mutations. 5 Both erlotinib and crizotinib are available at the VHA.

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