Dr. Shunyakov on the Impact of Next-Generation Sequencing in Oncology

Leonid Shunyakov, MD, hematologist/oncologist, Central Care Cancer Center, discusses the impact of next-generation sequencing (NGS) in oncology.

Genomics is a huge part of oncology, says Shunyakov, but there are limitations to the technology. There is disparity between different assays, says Shunyakov. FoundationOne and Guardant360 are the 2 most commonly used assays in practice, but the discordance rate is about 70% and the concordance rate is about 20% to 25%.

Physicians have used NGS to guide treatment selection in patients with a single driver mutation, but most cancers are much more complex and have more than one driver, explains Shunyakov.

Most recently, the CheckMate-227 trial assessed tumor mutational burden (TMB). The study was published in the New England Journal of Medicine and showed that high TMB could potentially be used as a predictive response to the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) in non—small cell lung cancer. The study showed a 1-year 43% progression-free survival rate in the combination group compared with 13% in chemotherapy.

Assessing TMB is just one of many novel ways of using NGS, says Shunyakov. Gaining knowledge at the molecular level about how genes work and using that knowledge to guide therapy is another novel way of using NGS.