An interview with Dr Fusco on the use of biomarker testing at early diagnosis
Dr Juan Paolo Fusco is a medical oncologist specialized in treating gastrointestinal tumors. He works at La Milagrosa Hospital in Madrid, Spain. Dr Fusco also acts as the deputy director of the medical oncology department of the GenesisCare group which combines about 20 medical centers and hospitals in Spain. Dr Fusco is an adept and genuine supporter of biomarker testing. In this interview, we asked him about his opinion on the value of the technology, the major barriers he faces in his daily routine, and the reasons why he decided to move comprehensive biomarker testing at early diagnosis in his patients’ cancer journey.
OncoDNA: Good morning, Dr Fusco. Since you started practicing oncology and treating patients from Spain and beyond, have you noticed any change in cancer care?
Dr Fusco: Lately, we have been living a revolution in oncology. We are now able to know the tumor biology and that knowledge allows us to guide personalized treatment decisions for our patients. I try to acquire that knowledge and draw the molecular profile of my patients’ tumors, because it helps me understand their diseases more accurately and choose the best treatment options for them.
OncoDNA: Do you use molecular profiling and recommend comprehensive biomarker testing for all your cancer patients?
Dr Fusco: In my daily practice, it is difficult to offer comprehensive biomarker tests to all patients. I sometimes face limitations. I don’t always have the opportunity to run such tests due to financial constraints. In general, insurance companies do not cover this kind of tests. The lack of reimbursement is a major barrier that prevents me from using biomarker testing on a wider scale.
OncoDNA: Based on your experience, what is the best time to use comprehensive biomarker tests?
Dr Fusco: I do recommend using comprehensive biomarker testing. Identifying patient-specific mutations in a tumor allows us, oncologists, to predict with more accuracy a therapeutic response and to personalize treatment for each patient. Several years ago, I used to test my patients at disease progression. Now, I prefer to use biomarker testing at diagnosis, because I want to be able to select the best treatments for my patient as early as possible. I want to know what all the therapeutic options are for this patient and map out his treatment journey. In an ideal world, I would try to run the tests at each and every progression phase. In general, I think it is important to move to comprehensive biomarker testing at early diagnosis and avoid delaying it until the late stages of a disease.
OncoDNA: Have you noticed any difference in your patients’ outcome since the integration of comprehensive biomarker testing in your clinical practice?
Dr Fusco: Biomarker testing changed the treatment pathway for an important part of my patients. Nowadays we can prescribe drugs that target specific proteins or mutations in a tumor. Next-generation sequencing collects insights on a tumor’s characteristics and identify such drugs. Combining next-generation sequencing with immunohistochemistry and potentially liquid biopsy helps obtain greater insights and spot more treatment options for our patients. I believe that the future is to combine the different technologies.
OncoDNA: Would you recommend comprehensive biomarker testing to any oncologists?
Dr Fusco: Thanks to biomarker testing, I move with more confidence. I know that I am choosing the most optimal treatment for my patients. In my opinion, if we want to have greater chances of success against the tumor, we need to know it from the inside.
OncoDNA: How do you see the future?
Dr Fusco: Generally speaking, I think that we are on the right track, but there is still a long way to go. In my opinion, personalized medicine is here to stay and we have to embrace it. It is already the present and it is going to be our future. So I would recommend to use comprehensive biomarker testing at the beginning of our patients’ treatment journey.