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Evolution of NGS in Cancer Care: From Research Tool to Clinical Standard

NextEdge Admin

30 Apr 2024

3 min 52 sec

Next-generation sequencing (NGS) has become indispensable in oncology, revolutionizing our approach to understanding cancer biology and guiding targeted therapy development. Initially confined to research settings, NGS has rapidly transitioned into routine clinical practice due to advancements in technology, decreased costs, and increased accessibility. However, this transition has brought forth several challenges, particularly in the interpretation of complex molecular datasets generated by large gene panels.

The European Society for Medical Oncology (ESMO) has responded to these challenges by introducing the ESMO scale of clinical actionability for molecular targets (ESCAT). This scale categorizes molecular alterations based on the level of clinical evidence supporting their association with targeted therapies. It provides guidance to clinicians in navigating the vast landscape of genomic alterations and selecting appropriate targeted treatments. Additionally, ESMO has published recommendations for the use of NGS in daily oncology practice, offering further guidance on testing modalities and clinical applications.

Despite the increasing adoption of NGS, there remains a debate regarding its optimal use outside of research settings. While routine multigene NGS testing is recommended for certain cancers with validated targeted therapies, such as non-squamous non-small-cell lung cancer (NSCLC), prostate cancer, ovarian cancer, and cholangiocarcinoma, its utility in other cancer types is still being evaluated. The decision to utilize NGS is often influenced by factors such as clinical context, availability, and reimbursement.

One major concern surrounding NGS implementation is the sheer volume of data generated and the challenge of interpreting it effectively. Molecular tumor boards have emerged as essential forums for multidisciplinary discussions, facilitating the interpretation of NGS results and guiding treatment decisions. These boards bring together oncologists, pathologists, molecular biologists, and other experts to collectively analyze genomic data and recommend personalized treatment strategies. Additionally, initiatives like The Drug Rediscovery protocol aim to leverage NGS data to identify off-label uses for approved drugs, thereby expanding treatment options for patients with rare genomic alterations.

Furthermore, NGS has proven valuable in identifying hereditary tumor syndromes and guiding treatment decisions for tumor-agnostic therapies, such as checkpoint inhibitors and NTRK inhibitors. Despite the rarity of these events, they offer significant therapeutic potential for patients lacking standard treatment options. NGS has transformed oncology practice by providing valuable insights into tumor biology and guiding targeted therapy selection. However, challenges persist in data interpretation and optimal utilization, necessitating ongoing research and collaborative efforts to maximize its clinical impact.