Role of CGP Testing in the Management of Cancer Treatment and Personalized Care

Comprehensive Genomic Profiling (CGP) is reshaping cancer treatment by enabling precision oncology at an unprecedented scale. Dr. Lucio N. Gordan, President and Managing Physician at the Florida Cancer Specialists & Research Institute (FCS), answers our questions in this interview and discusses the transformative role of CGP in clinical practice. Dr. Lucio Gordan emphasizes how integrating in-house genomic testing has streamlined patient management, improved diagnostic accuracy, and accelerated access to targeted therapies, ultimately enhancing patient outcomes.

Dr. Gordan, Discusses a Clinician’s Perspective on CGP

Dr. Lucio Gordan explains how integrating genomic testing has revolutionized cancer care at FCS by improving diagnostic precision, accelerating patient access to targeted therapies, and enhancing clinical outcomes. He also discusses the challenges of implementing CGP testing at scale and FCS’s commitment to advancing molecular diagnostics.

Click the picture to view the PDF version: Pg 12-14.

From a clinical perspective, what are the key advantages of integrating Comprehensive Genomic Profiling (CGP)  into routine cancer care? How does it enhance diagnostic precision and patient management?

Dr. Gordan: In the past decade, the rapid evolution of science, particularly with new therapeutics targeting specific molecular tumor signatures, has significantly impacted our work at FCS. We implemented comprehensive genomic profiling inhouse about  four years ago, which has greatly enhanced our ability to deliver precise treatments swiftly. 

Our own genomic database allows us to match patients with the most appropriate clinical trials, including phase I and phase II, more efficiently than before. This integration into our precision oncology platform has shortened our turnaround times, making us faster than any commercial laboratory. The success of these changes stems from our robust integration of comprehensive genomic profiling, proving extremely effective for our operations.

In your experience, do traditional testing methods meet the current needs of oncologists in cancer treatment, or is there a significant shortfall?

Dr. Gordan: At FCS, our shift from spot or limited panel testing to comprehensive genomic profiling has significantly expedited our process, particularly in advancing patients into phase I clinical trials and first-in-human trials. 

This evolution to a robust, fast comprehensive platform has greatly improved the standard of care we provide. We’re thrilled to continually expand our panels and enhance result turnaround times, reinforcing our role in pioneering effective solutions for our patients.

Reflecting on your practice, what are some notable changes in patient recovery and survival rates that you attribute to the adoption of CGP?
Dr. Gordan: It’s challenging to quantify exactly how much we’ve improved patient survival at FCS, but evidence strongly supports that the right therapy, guided by genomic profiling, is the most cost-effective and enhances both progression-free and overall survival and quality of life.

Our research shows that patients receiving genetic profiling early have fewer complications and hospitalizations, thanks to quicker access to targeted therapies. Our integrated systems streamline the process from testing to treatment implementation, greatly accelerating the timeline and improving outcomes. 

A multitude of studies confirm that comprehensive genomic profiling and appropriate treatment selection significantly boosts survival rates. Considering the extensive profiling we conduct, it’s clear we’re making a profound impact on our patients’ health.

What are some of the main challenges you face when incorporating CGP into everyday clinical practice, and how do you overcome them?

Dr. Gordan: We pioneered comprehensive genomic profiling in community oncology nationally, overcoming several hurdles to become the first to succeed on a large scale. Initially, the technological challenges involved onboarding new equipment and expanding our pathology and molecular departments. 

This was manageable as we could directly influence our ability to recruit and retain top talent. A tougher challenge was dealing with payers who were initially hesitant about our initiative, often not covering tests for reimbursement. However, our revenue cycle and contracting teams crafted a detailed action plan, successfully negotiating coverage for over 80% of our patients.

Navigating these obstacles is a process; we achieve small victories gradually leading to larger successes. Another significant challenge has been managing the vast amount of data generated and interpreting it effectively. We’ve addressed this through partnerships and by bolstering our internal data science and molecular capabilities. 

Challenges invigorate us—they are the reason we strive to expand and enhance our services early each day. Embracing genomic profiling was a significant, worthwhile challenge, and I’m eager to tackle more challenges, particularly looking to expand in the Biomedical department.

How has CGP testing influenced the success rates of cancer treatments in your experience, particularly in reducing inappropriate treatments and associated costs?

Dr. Gordan: The impact of detecting actionable mutations through genomic profiling is transformative. It’s well-documented across cancer studies that patients matched with drugs based on their genomic profiles experience better outcomes, including improved overall survival and progression-free survival, generally with fewer toxicities. Patients not only live longer but also stay out of hospitals, reducing costs for both healthcare systems and themselves. 

Healthier  patients means lower expenses all around. We often say that the most expensive therapy is the wrong one. Comprehensive genomic profiling enables us to pinpoint the best therapy for each patient, optimizing treatment effectiveness. It’s been incredibly rewarding to contribute to these clinical improvements and to see the substantial benefits firsthand.

Looking forward, how do you see CGP evolving in the clinical setting and how centralized and decentralized (inhouse) testing can enhance its integration into standard care?

Dr. Gordan: We are continuously expanding our genomic profiling capabilities, soon incorporating HRD testing, liquid biopsy and exploring circulating tumor DNA, among other advancements. This evolution from single tests and small panels to larger, more comprehensive panels is just the beginning. We are committed to further enhancing our molecular diagnostics, diving deeper into proteomics and other emerging areas. 

These developments will significantly improve patient management. The journey of expanding our molecular capabilities is ongoing, and we anticipate even more breakthroughs in the next several years. We are on a path to learning more and better targeting therapies.

What is your future perspective, and how can the new trend of genetic testing change the future of treatment and the quality of life for patients?

Dr. Gordan: We will continue leading in applying new molecular tests, enhancing our ability to identify specific patients for phase I clinical trials—a key area of our expertise. As we enhance our molecular profiling capabilities, we will improve in matching treatments and research to patients, which will undeniably improve clinical outcomes, including progression-free and overall survival. 

Additionally, we have expanded our data science and informatics department at FCS. Effective genomics requires expert informatics teams to interpret the data and report properly. Given our extensive FCS population base (millions of patients), strong computational and informatics support is essential to determine which patients will benefit most from specific therapeutic drugs.