Equity Challenges in Biomarker Testing and Novel Therapies

The selpercatinib discussion's emphasis on comprehensive biomarker testing led Dr. Shah to ask directly about equity: are novel drugs and the testing needed to identify eligible patients reaching everyone equally? Dr. Luo was candid about persistent gaps in lung cancer. Liquid biopsy is convenient, but its sensitivity and specificity in early-stage disease remain imperfect, so tissue biopsy is often still required — and access to interventional pulmonology or thoracic surgery to obtain that tissue is a bottleneck she sees regularly. She described still encountering new lung cancer diagnoses in 2026 where biomarker testing should have started four to six weeks earlier. Her hope is that the strength of the selpercatinib data will empower non-oncology providers to order testing sooner, even without fully interpreting the results themselves, trusting oncology colleagues to help with interpretation afterward. Dr. Chen confirmed the same pattern in GU oncology, introducing the AMPLITUDE trial, led by Dr. Neeraj Agarwal, which combined a PARP inhibitor with abiraterone and prednisone in metastatic hormone-sensitive prostate cancer with positive results. Despite that efficacy signal, she stressed that without adequate testing infrastructure, clinicians simply can't identify which patients qualify for state-of-the-art regimens — a gap she said her field still sees too often. Dr. Shah summarized the throughline as "testing, testing, testing," framing biomarker access — not drug efficacy — as the current rate-limiting step in delivering personalized oncology care, regardless of tumor type.