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Excellent point, Lisa. We have been trying to sort out how best to accomplish this at our institution. Prior to the adjuvant approval, we had obtained BRAF testing on patients with a high risk of recurrence (i.e. Stage IIC/IIIB/IIIC). Our practice will now be changing to include any Stage III patient. As previously noted, I/O therapy would be preferred, but targeted therapy is an alternative to observation for those with autoimmune conditions. The need for an FDA approved test complicates the situation as our in house test has a fast turn around time, but will not be enough to justify starting adjuvant therapy. So this is a work in progress for us! If anyone has a good system, please pass along!
Virginia