Personalizing Cancer Diagnosis and Treatment Through Pathology: Aamir Ehsan, MD

Oncology Data Advisor: Welcome to Oncology Data Advisor. I'm Keira Smith. Today I'm at the ASCO Annual Meeting in Chicago, speaking with Dr. Aamir Ehsan, who is President of CorePath Laboratories. Thank you for joining us.

Aamir Ehsan, MD: You're welcome.

Oncology Data Advisor: So, would you like to tell us a little bit about personalized and precise diagnosis of cancer by pathology?

Dr. Ehsan: Yes, sure. Thank you for the opportunity. My name, as you said, is Aamir Ehsan, representing a Clinical Laboratory Improvement Amendments (CLIA)/College of American Pathologists (CAP)–accredited lab, CorePath, in San Antonio. I'm here at ASCO 2022 in Chicago. Basically, I would like to talk about the importance of pathology diagnosis for personalized and precision cancer, which is so common and so prevalent in most of the patients every week, every day.

Anytime you hear the word cancer, it means a lot of things, right? It means any of our family members, any of our loved ones who have been affected by cancer. It has taken all our happiness, and memories, birthdays—you name it—graduation, and stuff like that. It has affected the quality of life for patients. So I would like to take few minutes to talk about what it means when the patient gets the cancer diagnosis and what impact it can have from the pathologist perspective.

Most of the time when we talk to the cancer patient about common things, a common question that cancer patients ask is, "Why does it happen to me?" Right? "Have I done anything wrong?" And "What does it mean to my quality of life? Am I going to live longer or not?" And "Is it going to affect my family?" And "I wish I would have known this earlier; before making the diagnosis right now, could it have been known by early detection?" Anything like that.

So typically, if you see any cancer patient and look at the journey of their diagnosis, it's pretty long. A patient feels unwell and they go to the primary care doctor. The primary care doctor does certain tests, and based on certain tests, they go and talk to the oncologist. And after they talk to the oncologist, the biopsy needs to be done, or the procedure need to be done. Another appointment is made to the radiologist and the surgeons. After the tissue diagnosis is obtained, then you go to the pathologist. So, the patient is already several weeks behind, waiting very impatiently and fearful, for the diagnosis.

Pathologists make the diagnosis; it takes a few days to make the diagnosis. Then all the data are presented in a multidisciplinary tumor board conference, certain decisions are made, more testing gets ordered, and it takes another few weeks to get all these results done. So really, when the patients start having symptoms, by the time it goes to the final treatment decision, it has been several weeks or a few months that have been wasted. There are many challenges and many opportunities to improve in health care to make the rapid diagnosis for these cancer patients.

Oncology Data Advisor: Yes. Thank you so much for explaining all of that. Is there anything else you would like to share about this?

Dr. Ehsan: So, we are here at ASCO, and the research focus is basically on the diagnosis of cancer and therapeutic implication when it comes to genomic medicine. You see all these posters today; everybody's talking about DNA and genomic medicine and its implication on diagnosis and treatment, but less is discussed and less is researched on early detection.

Early detection is really the key for so many cancers. The most important thing I would like to convey is, when you are making the diagnosis of cancer, the genomic medicine is moving so fast. The science is exploding, which is good for patient care, but at the same time, we are seeing actionable mutations. We are targeting treatment and expanding the life expectancy of patients. But there are a lot of arbitrary and unnecessary rules that have been in place from the compliance point of view, from the reimbursement point of view, from certain things that are restricting or limiting our capability of practicing medicine.

For example, there are certain tests as a pathologist that I can order, but I have to wait a certain number of days, like a 14-day rule, because billing is done a certain way in inpatient versus outpatient. I cannot test all the genes that are possibly actionable. I'm kind of restricted to testing a certain number of genes, like less than 50 genes or more than 50 genes. One gene that we know today might not be actionable, can be actionable the next week or the following month. So the science is exploding, but most of these tests, unfortunately, are still treated as investigational by the insurance companies. So while we have patient samples right in front of us, we are obligated to have preauthorization and other approval, which can delay the care, which can affect the patient's cancer tissue, and which are very important and very precious. We have to take certain action very quickly.

So those are all the certain roadblocks that we go through. My hope is that insurance companies really get in line with the exploding science that we have, so proper patient care can be taken care of. When we, as pathologists, look at the cancer diagnosis, irrespective as to whether this is going to be reimbursable or not, we know that this is a life—this is not a number—this is a patient's life at risk. So, we do all the necessary tests, which we believe, because we are all licensed physicians, which is important for taking care of the patient. As long as we can prolong the life of the patient and the quality of life of the patient, that's more important to us as a physician. My hope is that all these regulations and restrictions that we have from the insurance and from the arbitrary rules can be improved at the pace of the medicine, which is progressing very fast.

Oncology Data Advisor: Well, this is all very interesting to hear, so thank you so much for explaining all of it to us.

Dr. Ehsan: Thank you for your time.

Thank you for listening to this podcast, recorded live at the 2022 ASCO Annual Meeting, by Oncology Data Advisor and ConveyMED. For more expert perspectives on the latest in cancer research and treatment, be sure to subscribe to the podcast at conveymed.io and oncdata.com. Don't forget to follow us on social media for news, exclusive interviews, and more.

About Dr. Ehsan

Aamir Ehsan, MD, is the Founder and CEO of CorePath Laboratories in San Antonio, Texas. Dr. Ehsan specializes, and is American Board Certified, in anatomic and clinical pathology, hematopathology, molecular genetics, and transfusion medicine. Over the years he has continually contributed to research and science-work through peer-reviewed articles, textbook chapters, and presentations at national and international conferences.

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.