Molecular Testing in Metastatic Urothelial Cancer During COVID-19

Arlene O. Siefker-Radtke, MD: Now, the NCCN [National Cancer Comprehensive Network] guidelines advocate for testing for patients with stage IV disease, and they also recommend considering testing for patients with stage IIIB on a more selected basis. The patients I typically recommend testing for in that perioperative space as part of our standard of care strategy would be patients at high risk of recurrence. For instance, a patient who had neoadjuvant chemotherapy and at surgery still had high volume T3b or T4a or greater disease, or lymph node involvement due to their high rate of recurrence. Testing early can help us plan ahead and get patients on clinical trials and prepare them for what might be needed down the road. Are you facing any challenges, Scott, with the COVID-19 pandemic? I know it has been challenging for some patients getting access to care and getting tissue sent for review. Has the pandemic altered your strategy at all?

Scott T. Tagawa, MD, MS, FACP: Less so currently in New York. With the timing of the major outbreaks in different locations that’s obviously been different, and New York was one of the earlier time points. For instance, for research, but also for some of our standard of care, there was a slowdown based upon personnel being available in the laboratory. And some of those personnel shifted both from the research labs to clinical, as well as some in the clinical labs being shifted to doing PCR [polymerase chain reaction] testing for COVID-19, for instance. Some of our other testing was longer. Now, we’re more or less back to normal. Hopefully, that is maybe the new normal. But it is an issue, and I agree with you in terms of earlier testing because on a practical basis, sometimes it takes some time. And I would say particularly when the tissue does not exist at one’s home institution, getting that tissue is one step, and sometimes that may take days but sometimes it may take weeks just to get the tissue. That adds on to the turnaround time if the tissue is not in hand.

Arlene O. Siefker-Radtke, MD: Yes, that is one thing I’ve noticed with the pandemic, that if the tissue is from an outside hospital, it can be challenging to get it shipped quickly due to shortages and health care workers, pandemic social-distancing programs. It has taken weeks for some patients’ tissues to get shipped to a place that can do this testing. It’s another reason I advocate for testing as early as possible. When a patient presents to my clinic the first time with metastatic disease, I talk with them about mutation testing, especially since we do have a standard of care therapy available.

Transcript edited for clarity.