Conference Abstracts - Summit on Cancer Health Disparities (SCHD26)
Vol. 6, Issue Supplement 1, 2026 · S1-2
When Asking for Too Much Creates Inequity: Centralized NGS Workflow vs In House BRAF IHC in metastatic Colorectal Cancer
Nissim Benizri, MD,Yohann Pilon, MD,Irem Engin, MD(c),Eliana Rohr, MD,Petr Kavan, MD,Gerald Batist, MD,Alan Spatz, MD,Kim Ma, MD
Submission received: 2025-12-16 / Accepted: 2026-01-07 / Published: 2026-01-25
Abstract
Background
Timely access to molecular testing is essential for equitable delivery of precision oncology in metastatic colorectal cancer (mCRC). Rapid identification of BRAF V600E is particularly critical, as first-line BRAF-targeted therapy improves survival, demonstrated in the phase III BREAKWATER trial. However, in Canada, molecular testing frequently relies on send-out next-generation sequencing (NGS), which is costly, resource-intensive, and centralized in reference laboratories. These structural constraints can delay results and exacerbate geography- and system-based disparities in care, disproportionately affecting patients in remote regions and Indigenous communities. While not as comprehensive as NGS, immunohistochemistry (IHC) using the VE1 antibody—specific for the BRAF V600E class I mutation—may offer a more accessible and timely diagnostic approach for the only currently actionable BRAF alteration in mCRC. We evaluated the real-world impact of in-house VE1 IHC on molecular turnaround time (TAT) as a potential strategy to improve diagnostic equity.
Methods
This is a pilot retrospective cohort study of mCRC patients with treated at a large tertiary academic cancer center between 2018 and 2025. Molecular TAT, timing of results relative to the first oncology visit, and concordance between NGS and reflex BRAF V600E IHC were assessed.
Results
Among 157 patients, 128 (81.5%) underwent NGS and 37 underwent VE1 IHC. IHC significantly reduced pathology-to-report TAT compared with NGS (median 9 vs 19 days; p=0.004) and results were available substantially earlier relative to the first oncology visit (median 1 vs 28 days; p<0.001). Molecular results were available by the first visit in 48.4% of IHC cases versus 13.5% of NGS cases (p<0.001). Logistic regression demonstrated higher odds of result availability at first visit with IHC (OR 5.99, 95% CI 2.53–14.18). Among 35 paired cases, VE1 IHC and NGS showed complete concordance for BRAF V600E (κ=1.00).
Conclusions
VE1 IHC substantially improves molecular turnaround time and early access to actionable results, addressing key equity gaps inherent to centralized NGS workflows. While not a replacement for comprehensive genomic profiling, VE1 IHC represents a pragmatic, lower-resource strategy that may reduce structural barriers to timely precision oncology in mCRC. To support scalable implementation and national equity, we are developing standardized tumor microarrays for multicenter validation of BRAF V600E IHC across Canada.