Could you explain why care guidelines rapidly change and why it’s challenging for doctors to keep up with these guidelines and new precision therapies?

Dr. Gary Grad: Certainly, Noah. As we gain a deeper understanding of the molecular biology of breast cancer, new therapeutic targets are identified, leading to the development of novel drugs such as targeted therapies, antibody-drug conjugates, and immunotherapies. Additionally, the discovery of new biomarkers and advancements in diagnostic tools, like liquid biopsies and improved imaging, allow for more refined patient stratification and treatment selection. These rapid advancements can make it challenging for clinicians to either keep up with or even execute care plans consistent with the latest guideline updates. For example, in 2024, NCCN updated their guidelines for Breast Cancer 6 times.

Can you provide an example of a biomarker driven care gap that we see and why it often gets missed in clinical care?

Dr. Gary Grad: Despite significant advancements in breast cancer care, biomarker care gaps definitely persist in clinical practice. As you know, these gaps can lead to missed opportunities for timely interventions and guideline supported therapy options. Let’s take the case of patients who progress on endocrine therapy who may be appropriate for ESR1 testing. Guidelines recommend testing for ESR1 mutations on a specimen obtained after progression on endocrine therapy and to consider testing at subsequent progression events. Since ESR1 mutations can confer resistance to standard endocrine therapies and identifying these mutations is useful for expanding therapy options, this guideline is of significant clinical importance and could be detrimental to patient care if missed. In just the last couple years we have seen several trials continue to show the potential clinical actionability and benefit from identifying ESR1 mutations after progression on endocrine therapy.4

Why is it important to get patients on targeted therapy, and what are the outcomes for patients who receive these therapies?

Dr. Gary Grad: Many targeted therapies have shown improvements in patient outcomes. Studies have shown that patients receiving targeted therapies may experience better response rates and longer progression-free survival compared to traditional treatments. Let’s take the ESR1 example in metastatic breast cancer again. Some studies have demonstrated that patients with ESR1 mutations benefited from switching to alternative endocrine therapies or adding targeted agents, versus the standard-of-care (SOC), resulting in improved PFS.(1,2,3,4) The ability to tailor treatment based on specific biomarkers allows for more effective and personalized care, which could be crucial in improving outcomes.

How is Tempus working to improve these gaps in care with Tempus Next?

Dr. Gary Grad: Tempus Next provides near real-time alerts to clinicians, identifying patients who may have fallen off care guidelines, as well as feedback to help institutions understand trends in their patient population. By offering both retrospective and prospective analytics, Tempus Next enables provider sites or health care systems to assess baseline testing rates and adherence to guidelines prior to implementation, track improvements, and measure the changes in adherence to guideline-directed care. This combination of actionable clinical alerts and powerful analytics allows health systems to drive measurable improvements in precision medicine adoption in breast cancer care and helps facilitate comprehensive and personalized treatment for patients.