Clalit HMO to Launch Genetic Testing Program

Program meant to detect mutations early to tailor treatment for patients

The Clalit health maintenance organization will be launching a new diagnostic testing program for its members in the coming weeks. Under the program, the HMO's patients will have access to four genetic tests to detect genetic mutations that may affect what medical treatment is appropriate for individual patients.

The program, which is is expected to cost about NIS 5 million a year, was developed by a committee of experts and will be offered at no charge, as recommended by the panel.

The tests, which have been approved by the Israeli Health Ministry and the U.S. Food and Drug Administration, identify genetic mutations that indicate either improved or reduced effectiveness of certain medical treatments. One test, called IL28B, is designed for patients with Hepatitis C, and is used to identify patients who would respond positively to treatment with the drug Interferon.

The test also provides an indication of the risk that the patient will later require a liver transplant.

Another test, called HER2, is used to identify stomach cancer patients who will respond positively to a specific chemotherapy treatment. A third test, UGT1A1, provides an indication of the degree of toxicity of a certain chemotherapy treatment that is considered dangerous for 7-10 percent of patients with metastatic colon cancer.

Clalit, which provides medical care to 58 percent of the country's population, will also be offering a fourth test, to identify a genetic marker for Lynch syndrome, indicating a substantially increased risk of colon or uterine cancer. The test, called MSI, is designed for patients with risk factors for the disease, including people with a family history of cancer.

"The tests identify the presence of certain genetic mutations through blood samples or samples from cancerous tissue removed in a biopsy," said Haim Bitterman, Clalit's chief physician, who headed the panel that developed the recommendations on the testing. He said the HMO expected to expand the program in the future to include other markers of potential disease.

The panel also developed guidelines for patients whose results indicated that certain medical treatments were not likely to be effective for them. "We're not leaving any patient without treatment," Bitterman added, saying other drugs would be prescribed instead.

The new tests have the potential of saving Clalit money by limiting expensive cancer treatments to those patients with good prospects for responding well to the prescribed medical care. Bitterman said, however, that the tests were not routinely administered in many countries, an indication that they do not save health care systems money.

"By providing better medical care, however, ultimately it is reasonable to expect that the cost of care will be less," he acknowledged.

In recent years, Israel's HMOs have begun offering three other genetic tests for breast cancer patients, for patients with cancer that has spread, and for some colon cancer patients.