Companion Diagnostics for Cancer Therapy

Companion diagnostics are tests – often assays – that are developed along with a medicine for use in deciding which patients to treat with the medicine.

This paradigm stands apart from most medical practice where drugs and diagnostics are separately ordered by doctors. The companion diagnostic for a targeted therapy is part of the package with the actual medicine. Tastuzumab and imatinib were early cancer drugs that required companion diagnostics with administration. The FDA’s approval of alpelisib in May 2019 came with a requirement that the therascreen PIK3CA RGQ PCR Kit be used on patients to detect the PIK3CA mutation before treatment.

The nature of the companion diagnostic (CDx) can take many forms: nucleic acid–based testing (there are a bunch), as well as less esoteric measures of blood serum and urine (e.g. biomarker proteins and metabolites that show evidence of pharmaceutical action).  Use may help avoid adverse drug reactions.  More than 40 companion diagnostics have been authorized by the FDA.

Complementary Diagnostics

In 2016 FDA employees at a meeting of the American Association for Cancer Research meeting explained the agency’s thinking on companion and complementary diagnostics.  An account stated “ while a complementary oncology in the clinicdiagnostic is able to provide additional information as to how a drug might be used, it is not the same as a companion diagnostic, which is essential for the safe and effective use of a drug.”  Some observers  reserve the word complementary for things like PD-L1 immunohistochemistry (IHC) assays used in conjunction with PD-1/PD-L1 immune checkpoint inhibitors.

The FDA website lists approved companion diagnostic devices at this website.  As of mid 2022, the oncology diagnostics were:

 

 

 

Name of DiagnosticIndicationDrugBiomarker(s)
Abbott RealTime IDH1 (Abbott Molecular, Inc.)Acute Myeloid Leukemia – Peripheral Blood or Bone MarrowIvosidenibIDH1
Abbott RealTime IDH2 (Abbott Molecular, Inc.)Acute Myeloid Leukemia – Peripheral Blood or Bone MarrowEnasidenibIDH2
Bond Oracle HER2 IHC System (Leica Biosystems)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
BRACAnalysis CDx (Myriad Genetic Laboratories, Inc.)Ovarian Cancer – Whole BloodOlaparib
BRCA1 and BRCA2
BRACAnalysis CDx (Myriad Genetic Laboratories, Inc.)Breast Cancer – Whole BloodOlaparib
BRCA1 and BRCA2
BRACAnalysis CDx (Myriad Genetic Laboratories, Inc.)Breast Cancer – Whole BloodTalazoparib
BRCA1 and BRCA2
BRACAnalysis CDx (Myriad Genetic Laboratories, Inc.)Ovarian Cancer – Whole BloodRucaparib
BRCA1 and BRCA2
BRACAnalysis CDx (Myriad Genetic Laboratories, Inc.)Pancreatic Cancer – Whole BloodOlaparib
BRCA1 and BRCA2
BRACAnalysis CDx (Myriad Genetic Laboratories, Inc.)Metastatic Castrate Resistant Prostate Cancer (mCRPC) – Whole BloodOlaparib
BRCA1 and BRCA2
cobas 4800 BRAF V600 Mutation Test (Roche Molecular Systems, Inc.)Melanoma – TissueVemurafenibBRAF
cobas 4800 BRAF V600 Mutation Test (Roche Molecular Systems, Inc.)Melanoma – TissueCobimetinib in combination with VemurafenibBRAF
cobas EGFR Mutation Test v1 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueErlotinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueOsimertinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueOsimertinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaOsimertinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – Tissue or PlasmaGefitinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – Tissue or PlasmaGefitinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – Tissue or PlasmaErlotinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – Tissue or PlasmaAfatinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – Tissue or PlasmaOsimertinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaOsimertinibEGFR (HER1)
cobas EGFR Mutation Test v2 (Roche Molecular Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaErlotinibEGFR (HER1)
cobas EZH2 Mutation Test (Roche Molecular Systems, Inc.)Follicular Lymphoma Tumor – TissueTazemetostatEZH2
cobas KRAS Mutation Test (Roche Molecular Systems, Inc.)Colorectal Cancer – TissueCetuximabKRAS
cobas KRAS Mutation Test (Roche Molecular Systems, Inc.)Colorectal Cancer – TissuePanitumumabKRAS
Dako c-KIT pharmDx (Dako North America, Inc.)Gastrointestinal Stromal Tumors – TissueImatinib mesylateC-Kit
Dako EGFR pharmDx Kit (Dako North America, Inc.)Colorectal Cancer – TissueCetuximabEGFR (HER1)
Dako EGFR pharmDx Kit (Dako North America, Inc.)Colorectal Cancer – TissuePanitumumabEGFR (HER1)
FoundationFocus CDxBRCA Assay (Foundation Medicine, Inc.)Ovarian Cancer – TissueRucaparib
BRCA1 and BRCA2
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueAfatinibEGFR (HER1)
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueGefitinibEGFR (HER1)
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueErlotinibEGFR (HER1)
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueOsimertinibEGFR (HER1)
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueAlectinibALK
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueCrizotinibALK
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueCeritinibALK
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueDabrafenib in combination with TrametinibBRAF
FoundationOne CDx (Foundation Medicine, Inc.)Breast Cancer – TissueTrametinibERBB2 (HER2)
FoundationOne CDx (Foundation Medicine, Inc.)Breast Cancer – TissuePertuzumabERBB2 (HER2)
FoundationOne CDx (Foundation Medicine, Inc.)Breast Cancer – TissueAdo-trastuzumab emtansineERBB2 (HER2)
FoundationOne CDx (Foundation Medicine, Inc.)Colorectal Cancer – TissueCetuximabKRAS
FoundationOne CDx (Foundation Medicine, Inc.)Colorectal Cancer – TissuePanitumumab
KRAS and NRAS
FoundationOne CDx (Foundation Medicine, Inc.)Ovarian Cancer – TissueRucaparib
BRCA1 and BRCA2
FoundationOne CDx (Foundation Medicine, Inc.)Melanoma – TissueTrametinibBRAF
FoundationOne CDx (Foundation Medicine, Inc.)Ovarian Cancer – TissueOlaparib
BRCA1 and BRCA2
FoundationOne CDx (Foundation Medicine, Inc.)Breast Cancer – TissueOlaparibPIK3CA
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueOsimertinibEGFR (HER1)
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueCapmatinibMET
FoundationOne CDx (Foundation Medicine, Inc.)Cholangiocarcinoma – TissuePemigatinibFGFR2
FoundationOne CDx (Foundation Medicine, Inc.)Metastatic Castrate Resistant Prostate Cancer (mCRPC) – TissueOlaparib
Homologous recombination repair (HRR) genes
FoundationOne CDx (Foundation Medicine, Inc.)Solid Tumors – TissuePembrolizumabTMB
FoundationOne CDx (Foundation Medicine, Inc.)Solid Tumors – TissueLarotrectinib
NTRK1, NTRK2 and NTRK3
FoundationOne CDx (Foundation Medicine, Inc.)Cholangiocarcinoma – TissueInfigratinibFGFR2
FoundationOne CDx (Foundation Medicine, Inc.)Solid Tumors – TissuePembrolizumabMSI-High
FoundationOne CDx (Foundation Medicine, Inc.)Melanoma – TissueAtezolizumab in combination with Cobimetinib and VemurafenibBRAF
FoundationOne CDx (Foundation Medicine, Inc.)Solid Tumors – TissueEntrectinib
NTRK1, NTRK2 and NTRK3
FoundationOne CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueEntrectinibROS1
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaGefitinibEGFR (HER1)
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaOsimertinibEGFR (HER1)
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaErlotinibEGFR (HER1)
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Metastatic Castrate Resistant Prostate Cancer (mCRPC) – PlasmaRucaparib
BRCA1 and BRCA2
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaCapmatinibMET
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaAlectinibALK
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Ovarian Cancer – PlasmaRucaparib
BRCA1 and BRCA2
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Breast Cancer – PlasmaAlpelisibPIK3CA
FoundationOne Liquid CDx (Foundation Medicine, Inc.)Metastatic Castrate Resistant Prostate Cancer (mCRPC) – PlasmaOlaparib
BRCA1, BRCA2 and ATM
Guardant360 CDx (Guardant Health, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaOsimertinibEGFR (HER1)
Guardant360 CDx (Guardant Health, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaAmivantambEGFR (HER1)
Guardant360 CDx (Guardant Health, Inc.)Non-Small Cell Lung Cancer (NSCLC) – PlasmaSotorasibKRAS
HER2 CISH pharmDx Kit (Dako Denmark A/S)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
HER2 FISH pharmDx Kit (Dako Denmark A/S)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
HER2 FISH pharmDx Kit (Dako Denmark A/S)Gastric and Gastroesophageal Cancer – TissueTrastuzumabERBB2 (HER2)
HER2 FISH pharmDx Kit (Dako Denmark A/S)Breast Cancer – TissuePertuzumabERBB2 (HER2)
HER2 FISH pharmDx Kit (Dako Denmark A/S)Breast Cancer – TissueAdo-trastuzumab emtansineERBB2 (HER2)
HercepTest (Dako Denmark A/S)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
HercepTest (Dako Denmark A/S)Gastric and Gastroesophageal Cancer – TissueHerceptin (trastuzumab) BLA 103792ERBB2 (HER2)
HercepTest (Dako Denmark A/S)Breast Cancer – TissuePertuzumabERBB2 (HER2)
HercepTest (Dako Denmark A/S)Breast Cancer – TissueAdo-trastuzumab emtansineERBB2 (HER2)
INFORM HER-2/neu (Ventana Medical Systems, Inc.)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
INFORM HER2 Dual ISH DNA Probe Cocktail (Ventana Medical Systems, Inc.)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
INFORM HER2 Dual ISH DNA Probe Cocktail (Ventana Medical Systems, Inc.)Breast Cancer – TissueAdo-trastuzumab emtansineERBB2 (HER2)
InSite Her-2/neu (CB11) Monoclonal Antibody (Biogenex Laboratories, Inc.)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
Ki-67 IHC MIB-1 pharmDx (Dako Omnis) (Agilent Technologies)Breast Cancer – TissueAbemaciclibKi-67
KIT D816V Assay (ARUP Laboratories, Inc.)Aggressive Systemic Mastocytosis – Bone MarrowImatinib mesylateKIT
LeukoStrat CDx FLT3 Mutation Assay (Invivoscribe Technologies, Inc.)Acute Myelogenous Leukemia – Peripheral Blood or Bone MarrowMidostaurinFLT3 (ITD/TDK)
LeukoStrat CDx FLT3 Mutation Assay (Invivoscribe Technologies, Inc.)Acute Myelogenous Leukemia – Peripheral Blood or Bone MarrowGilterinibFLT3 (ITD/TDK)
MRDx BCR-ABL Test (MolecularMD Corporation)Chronic Myeloid Leukemia – Peripheral BloodNilotinib
t(9;21) Philadelphia chromosome
Myriad myChoice CDx (Myriad Genetic Laboratories, Inc.)Ovarian Cancer – TissueNiraparibMyriad HRD
Myriad myChoice CDx (Myriad Genetic Laboratories, Inc.)Ovarian Cancer – TissueOlaparibMyriad HRD
ONCO/Reveal Dx Lung & Colon Cancer Assay (O/RDx-LCCA) (Pillar Biosciences, Inc.)Colorectal Cancer – TissueCetuximabKRAS
ONCO/Reveal Dx Lung & Colon Cancer Assay (O/RDx-LCCA) (Pillar Biosciences, Inc.)Colorectal Cancer – TissuePanitumumabKRAS
ONCO/Reveal Dx Lung & Colon Cancer Assay (O/RDx-LCCA) (Pillar Biosciences, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueGefitinibEGFR (HER1)
ONCO/Reveal Dx Lung & Colon Cancer Assay (O/RDx-LCCA) (Pillar Biosciences, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueAfatinibEGFR (HER1)
ONCO/Reveal Dx Lung & Colon Cancer Assay (O/RDx-LCCA) (Pillar Biosciences, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueErlotinibEGFR (HER1)
ONCO/Reveal Dx Lung & Colon Cancer Assay (O/RDx-LCCA) (Pillar Biosciences, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueDacomitinibEGFR (HER1)
Oncomine Dx Target Test (Life Technologies Corporation)Non-Small Cell Lung Cancer (NSCLC) – TissueDabrafenib in combination with TrametinibBRAF
Oncomine Dx Target Test (Life Technologies Corporation)Non-Small Cell Lung Cancer (NSCLC) – TissueCrizotinibROS1
Oncomine Dx Target Test (Life Technologies Corporation)Non-Small Cell Lung Cancer (NSCLC) – TissueGefitinibEGFR (HER1)
Oncomine Dx Target Test (Life Technologies Corporation)Non-Small Cell Lung Cancer (NSCLC) – TissuePralsetinibRET
Oncomine Dx Target Test (Life Technologies Corporation)Non-Small Cell Lung Cancer (NSCLC) – TissueAmivantambEGFR (HER1)
Oncomine Dx Target Test (Life Technologies Corporation)Cholangiocarcinoma – TissueIvosidenibIDH1
Oncomine Dx Target Test (Life Technologies Corporation)Non-Small Cell Lung Cancer (NSCLC) – TissueMobocertinibEGFR (HER1)
PathVysion HER-2 DNA Probe Kit (Abbott Molecular Inc.)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
PATHWAY anti-Her2/neu (4B5) Rabbit Monoclonal Primary Antibody (Ventana Medical Systems, Inc.)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
PATHWAY anti-Her2/neu (4B5) Rabbit Monoclonal Primary Antibody (Ventana Medical Systems, Inc.)Breast Cancer – TissueAdo-trastuzumab emtansineERBB2 (HER2)
PD-L1 IHC 22C3 pharmDx (Dako North America, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissuePembrolizumabPD-L1
PD-L1 IHC 22C3 pharmDx (Dako North America, Inc.)Cervical Cancer – TissuePembrolizumabPD-L1
PD-L1 IHC 22C3 pharmDx (Dako North America, Inc.)Head and Neck Squamous Cell Carcinoma (HNSCC) – TissuePembrolizumabPD-L1
PD-L1 IHC 22C3 pharmDx (Dako North America, Inc.)Esophageal Squamous Cell Carcinoma (ESCC) – TissuePembrolizumabPD-L1
PD-L1 IHC 22C3 pharmDx (Dako North America, Inc.)Triple-Negative Breast Cancer (TNBC) – TissuePembrolizumabPD-L1
PD-L1 IHC 22C3 pharmDx (Dako North America, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueCemiplimab-rwlcPD-L1
PD-L1 IHC 28-8 pharmDx (Dako North America, Inc.)Non-small cell lung cancer (NSCLC) – TissueNivolumab in combination with IpilimumabPD-L1
PDGFRB FISH Assay (ARUP Laboratories, Inc.)Myelodysplastic Syndrome/Myeloproliferative Disease – Bone MarrowImatinib mesylatePDGFRB
Praxis Extended RAS Panel (Illumina, Inc.)Colorectal cancer – TissuePanitumumab
KRAS and NRAS
SPOT-LIGHT HER2 CISH Kit (Life Technologies Corporation)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
therascreen BRAF V600E RGQ PCR Kit (QIAGEN GmbH)Colorectal Cancer – TissueEncorafenib in combination with CetuximabBRAF
therascreen EGFR RGQ PCR Kit (Qiagen Manchester, Ltd.)Non-Small Cell Lung Cancer (NSCLC) – TissueAfatinibEGFR (HER1)
therascreen EGFR RGQ PCR Kit (Qiagen Manchester, Ltd.)Non-Small Cell Lung Cancer (NSCLC) – TissueGefitinibEGFR (HER1)
therascreen EGFR RGQ PCR Kit (Qiagen Manchester, Ltd.)Non-Small Cell Lung Cancer (NSCLC) – TissueAfatinibEGFR (HER1)
therascreen EGFR RGQ PCR Kit (Qiagen Manchester, Ltd.)Non-Small Cell Lung Cancer (NSCLC) – TissueDacomitinibEGFR (HER1)
therascreen FGFR RGQ RT-PCR Kit (QIAGEN Manchester Ltd.)Urothelial Cancer – TissueErdafitinibFGFR3
therascreen KRAS RGQ PCR Kit (Qiagen Manchester, Ltd.)Colorectal Cancer – TissuePanitumumabKRAS
therascreen KRAS RGQ PCR Kit (Qiagen Manchester, Ltd.)Non-Small Cell Lung Cancer (NSCLC) – TissueSotorasibKRAS
therascreen KRAS RGQ PCR Kit (Qiagen Manchester, Ltd.)Colorectal Cancer – TissueCetuximabKRAS
therascreen PIK3CA RGQ PCR Kit (QIAGEN GmbH)Breast Cancer – Tissue or PlasmaAlpelisibPIK3CA
THXID BRAF Kit (bioMérieux Inc.)Melanoma – TissueTrametinibBRAF
THXID BRAF Kit (bioMérieux Inc.)Melanoma – TissueDabrafenibBRAF
THXID BRAF Kit (bioMérieux Inc.)Melanoma – TissueEncorafenib in combination with BinimetinibBRAF
Ventana ALK (D5F3) CDx Assay (Ventana Medical Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueCrizotinibALK
Ventana ALK (D5F3) CDx Assay (Ventana Medical Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueCeritinibALK
Ventana ALK (D5F3) CDx Assay (Ventana Medical Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueAlectinibALK
Ventana ALK (D5F3) CDx Assay (Ventana Medical Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueLorlatinibALK
Ventana HER2 Dual ISH DNA Probe Cocktail (Ventana Medical Systems, Inc.)Breast Cancer – TissueTrastuzumabERBB2 (HER2)
Ventana MMR RxDx Panel (Ventana Medical Systems, Inc.)Endometrial Carcinoma (EC) – TissueDostarlimag-gxly
deficient mismatch repair (dMMR) proteins
Ventana MMR RxDx Panel (Ventana Medical Systems, Inc.)Endometrial Carcinoma (EC) – TissuePembrolizumab in combination with Lenvatinib
deficient mismatch repair (dMMR) proteins
Ventana PD-L1 (SP142) Assay (Ventana Medical Systems, Inc.)Urothelial Carcinoma – TissueAtezolizumabPD-L1
Ventana PD-L1 (SP142) Assay (Ventana Medical Systems, Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueAtezolizumabPD-L1
Ventana PD-LI (SP263) Assay (Ventana Medical Systems, Inc)Non-Small Cell Lung Cancer (NSCLC) – TissueAtezolizumabPD-L1
Vysis ALK Break Apart FISH Probe Kit (Abbott Molecular Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueCrizotinibALK
Vysis ALK Break Apart FISH Probe Kit (Abbott Molecular Inc.)Non-Small Cell Lung Cancer (NSCLC) – TissueBrigatinibALK
Vysis CLL FISH Probe Kit (Abbott Molecular, Inc.)B-cell Chronic Lymphocytic Leukemia – Peripheral BloodVenetoclaxTP53