Maher Albitar, MD, founder, chief executive officer, chief medical officer, Genomic Testing Cooperative, and Andre H. Goy, MD, physician in chief of the Hackensack Meridian Health Oncology Care Transformation Services, chairman and chief physician officer at John Theurer Cancer Center at Hackensack University Medical Center, and Lymphoma Division Chief at the John Theurer Cancer Center, discuss case studies in diffuse large B-cell lymphoma (DLBCL).

DLBCL is a heterogeneous disease, making subclassification extremely important for proactive clinical decision making, Albitar says. For example, the curability of DLBCL with R-CHOP (rituximab [Rituxan] with cyclophosphamide, doxorubicin, vincristine, and prednisone) goes down in elderly patients, those with a high-risk International Prognostic Index, and those with high-risk molecular subtypes, Goy says.

The stratification of a patient’s risk and ultimate prognosis can be best understood through routine DNA and RNA next-generating sequencing because it can identify chromosomal structural abnormalities and mutations within the germinal cell and activated B-cell–like subtypes. Patients with mutations such as 

 are often refractory to chemotherapy and need new treatment options. One such option that has been evaluated in the relapsed/refractory setting is the combination of lenalidomide (Revlimid) and rituximab plus ibrutinib (Imbruvica), Goy says.

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Maher Albitar, MD, and Andre H. Goy, MD, discuss case studies in diffuse large B-cell lymphoma.

Inside the Clinic: Experts Explore Case Studies in DLBCL

Maher Albitar, MD, founder, chief executive officer, chief medical officer of Genomic Testing Cooperative, and Andre H. Goy, MD, physician in chief of the Hackensack Meridian Health Oncology Care Transformation Services, chairman and chief physician officer at John Theurer Cancer Center at Hackensack University Medical Center, and Lymphoma Division Chief at John Theurer Cancer Center, discuss the importance of testing for molecular abnormalities in acute myeloid leukemia (AML).

The AML treatment landscape is growing rapidly and becoming increasingly complex, and investigative measures have evolved past the abilities of cytogenetics and fluorescence in situ hybridization (FISH) testing, Goy says. Instead, extensive molecular profiling is effective at identifying high-risk patients to best customize their treatment. Instead of being tested for individual suspected mutations, patients should receive one comprehensive test to reveal the entire genomic profile of their disease, Goy adds.

Advances in DNA and RNA next-generation sequencing (NGS) have allowed for greater visibility of genetic abnormalities, immunophenotypes, and heterogeneities within AML, Albitar says. Additionally, as leukemias are immersed in the blood, liquid biopsy is a reliable means of evaluating disease status and detecting these molecular and cytogenetic abnormalities.

Tracking the clonal evolution of molecular abnormalities over time is essential for identifying mutations and administering effective treatment, Goy adds. Strategic treatment produces better survival outcomes with more tolerable toxicity.

Each patient is different, and new combination therapies, especially those being introduced in clinical trials, offer opportunities to find better biomarkers for determining which combinations to use for which patients, Albitar says. NGS is becoming an important routine practice for clinical decisions and monitoring patient responses to targeted therapies, Goy concludes.

Maher Albitar, MD, and Andre H. Goy, MD, discuss the importance of testing for molecular abnormalities in acute myeloid leukemia. 

Inside the Clinic: Experts Discuss Testing for Molecular Abnormalities in AML 

Maher Albitar, MD, founder, chief executive officer, chief medical officer of Genomic Testing Cooperative, and Andre H. Goy, MD, physician in chief of the Hackensack Meridian Health Oncology Care Transformation Services, chairman and chief physician officer at John Theurer Cancer Center at Hackensack University Medical Center, and Lymphoma Division Chief at John Theurer Cancer Center, share insights regarding molecular complexities in mantle cell lymphoma (MCL).

Many patients with MCL who are not ideal candidates for standard therapies like chemotherapy or chemoimmunotherapy need refined treatment options that best fit their unique gene expression and disease profile, Goy says. Molecular abnormalities provide crucial information about patients that can be used to monitor their mutations, as well as detect minimal residual disease (MRD) and early relapse, Albitar adds.

In their discussion, Albitar and Goy share a case study of a 55-year-old patient with indolent MCL with gastrointestinal involvement whose symptoms progressed over 8 years of observation. This patient exhibited several structural and chromosomal abnormalities typical of evolving MCL that made them a poor candidate for chemoimmunotherapy, Goy explains. Instead of standard therapy, this patient was given rituximab (Rituxan) plus a BTK inhibitor for 3 months and became MRD negative. This is a prime example of the need to use liquid biopsy to explore potential inherited abnormalities to provide the best treatment and follow-up, Albitar continues.

Conducting next-generation sequencing (NGS) also provides a diagnostic advantage when investigating treatment methods for patients with MCL, as it allows for knowledge of somatic landscapes based on regional abnormalities, Goy says. NGS detects multiple genes at once and can indicate which subclone is going to emerge as more aggressive so therapy can be adjusted accordingly, Albitar concludes.

Maher Albitar, MD, and Andre H. Goy, MD, share insights regarding molecular complexities in mantle cell lymphoma.

Inside the Clinic: Experts Highlight Molecular Complexities in MCL 

Maher Albitar, MD, founder, chief executive officer, chief medical officer, Genomic Testing Cooperative, and Andre H. Goy, MD, physician in chief of the Hackensack Meridian Health Oncology Care Transformation Services, chairman and chief physician officer at John Theurer Cancer Center at Hackensack University Medical Center, and Lymphoma Division Chief at the John Theurer Cancer Center, discuss practical aspects of next-generation sequencing (NGS).

In 2022, liquid biopsy is used in combination with tissue biopsy across the spectrum of oncology management. Liquid biopsy has several applications and can be used to refine a diagnosis, stratify patients and select treatment, predict response and outcomes to therapy, and identify minimal residual disease and early relapse, Goy says. Moreover, ongoing research is evaluating the use of liquid biopsy for early diagnosis.

Both RNA and DNA sequencing are used, but RNA sequencing is the most reliable method for detecting gene fusions, Goy says. The applications for NGS are growing, and assays can do much more than identify a point mutation, Albitar says. Moreover, because of technology improvements, less tissue is required for testing, and turnaround times range from 5 to 10 days, Albitar adds.

Maher Albitar, MD, and Andre H. Goy, MD, discuss practical aspects of next-generation sequencing.

Inside the Clinic: Experts Discuss Practical Aspects of Next-Generation Sequencing

Maher Albitar, MD, founder, chief executive office, chief medical officer, Genomic Testing Cooperative, discusses the importance of obtaining genomic testing in oncology.

Obtaining genomic information in oncology can inform a patient’s diagnosis, Albitar says. Moreover, genomic testing can help in understanding complicated disease presentations.

Additionally, genomic information can provide insight into a patient’s prognosis, treatment selection, long-term management strategies, minimal residual disease, comorbidity factors, and the risk of adverse effects of therapy, Albitar explains. Ultimately, obtaining genomic testing can help to guide providers and patients through common challenges encountered during the patient’s disease course and cancer treatment journey, Albitar concludes.

Maher Albitar, MD, discusses the importance of obtaining genomic testing in oncology.  



Maher Albitar, MD

Articles

Inside the Clinic: Experts Explore Case Studies in DLBCL

Inside the Clinic: Experts Discuss Testing for Molecular Abnormalities in AML

Inside the Clinic: Experts Highlight Molecular Complexities in MCL

Inside the Clinic: Experts Discuss Practical Aspects of Next-Generation Sequencing

Dr. Albitar on the Importance of Obtaining Genomic Testing in Oncology