Personalized cancer care — where cancer therapies are tailored to the genomic makeup of a patient and their tumor — is no longer a futuristic concept. It’s now a reality. Precision oncology has moved from the research setting into routine clinical practice, reshaping how clinicians assess risk, select treatments and monitor for recurrence.
But translating that promise into consistent, systemwide results is no small task. It demands close collaboration among clinicians, health systems, researchers, technology partners and industry, along with the infrastructure to make genomic insights actionable at the point of care.
To explore what precision oncology looks like in practice today — and where it’s headed next — Becker’s Healthcare spoke with Minetta Liu, MD, chief medical officer of oncology and early cancer detection at Natera.
Question: Precision oncology has moved from concept to practice, but implementation still looks very different from one organization to the next. What does it look like on the ground, and where is it making the biggest difference for patients?
Dr. Minetta Liu: Precision oncology enables personalized cancer care and is achieved through genomics. Germline genetic testing determines hereditary cancer risk so that patients and their families can consider more intensive, but focused, screening programs. Genomic tumor profiling, on the other hand, can identify treatment opportunities tailored to the specific biology of a given cancer.
We now have circulating tumor DNA analysis to detect molecular residual disease, as well. In the absence of radiographic findings, this transformative technology supports longitudinal monitoring at the molecular level to facilitate timely intervention and treatment optimization. In some cases, it reduces unnecessary therapy exposure.
Precision oncology has evolved from highly specialized centers to routine clinical practice. However, maturity varies significantly between organizations. With the variety of available tests, operational challenges to effective implementation include standardization of clinical pathways, the availability of embedded genomic workflows and molecular tumor boards, and EHR integration.
Q: Genomic information holds real potential to improve treatment decisions and family risk conversations. Yet, integrating it into everyday workflows takes careful thought. How should health systems approach that without overwhelming care teams?
ML: The key to operationalizing precision oncology in clinical practice is integrating genomic testing into clinical workflows. Parallel systems for “specialty tests” increase burden on clinicians and staff. This applies to orders, biospecimen collection and shipment, and return of results.
Health systems should focus on standardization and clinical decision support. Providers don’t have time to navigate a multitude of different testing options or manually interpret complex genomic reports. It’s essential to embed evidence-based guidance directly into the EHR, create streamlined ordering pathways and leverage multidisciplinary support teams.
This requires cross-functional support from genetics, pathology, pharmacy, informatics, nursing, navigation and operations. All teams must work together as a coordinated system. Collaboration with commercial testing partners is also critical.
Q: You’ve been a strong advocate for circulating tumor DNA (ctDNA) and molecular residual disease (MRD) testing as tools for personalizing surveillance and detecting recurrence earlier. What is the biggest barrier to broader adoption of this approach? What would help health systems move past it?
ML: Assessing disease status in real time through serial ctDNA testing of the peripheral blood is redefining the management of early-stage cancer. It provides a quantifiable tumor measurement in the absence of clinical or radiographic findings.
Natera is at the forefront of generating data supporting the role of MRD detection in three important activities – prognostication, treatment response monitoring, and surveillance for cancer recurrence. In terms of prognosis, MRD detection is a powerful prognostic factor, enabling clinicians to tailor adjuvant treatment based on the risk of recurrence. To facilitate dynamic treatment response monitoring, MRD provides a reliable tool that ensures the current therapy is effective. When it comes to active surveillance, MRD detection can detect recurrence earlier when a “second chance” at cure is possible.
Over time, ctDNA testing will increasingly help guide treatment optimization, surveillance intensity and clinical trial enrollment. Broader adoption of ctDNA testing for MRD detection requires ongoing prospective evidence generation, clearer alignment with practice guidelines, stronger reimbursement pathways and seamless integration into clinical workflows. Clinicians need confidence in operationalizing these tools across large patient populations.
Q: Making precision oncology work reliably across community sites, pathology, genomics, pharmacy and care navigation is challenging. What makes the biggest difference when turning it into a true systemwide capacity?
ML: Successful, system-wide implementation of precision oncology in community practices requires an enterprise strategy approach. That includes governance structures, evidence-based clinical pathways, investment in the informatics infrastructure and shared accountability across departments. Standardized test menus, strong EHR integration and centralized genomic review processes, like molecular tumor boards, are critical for operational sustainability.
Q: Looking ahead, what developments in precision oncology excite you most?
ML: By moving beyond targeted therapy for metastatic disease to continuous reassessment of a tumor’s biology, we can adapt care and administer therapy when it’s clinically meaningful.
The standard of care in oncology is advancing with the advent of multimodal testing approaches and big data capabilities. The next frontier will be expanding cancer screening to all cancer types and improving access to care through blood-based testing, rather than procedure-based testing.
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