Timing and Utility of Next-Generation Sequencing

CancerTREATMENT NGS+ is a platform that is used for molecular testing of various cancers, explains Suresh S. Ramalingam, MD. The testing platform combines a next-generation sequencing (NGS) component with selected IHC/FISH tests that identify biomarkers for specific targeted therapies, such as aberrations in ALK and ROS1 in lung cancer. When ordering a test for a patient with lung cancer, the FDA approved companion diagnostic FISH test would be used to identify the actionable biomarker while the NGS component would help find markers that are being assessed in clinical trials, like PD-L1, Ramalingam explained.

Molecular testing may be ordered at the time of a patient’s diagnosis or when clinicians are approaching treatment decisions in second- and third-line settings. Ramalingam’s institution tests every patient with nonsquamous, non-small cell lung cancer but refrains from making an early treatment decision based on the results, since adjuvant chemotherapy is the standard of care in this population. The information becomes important in recurrent disease.

Molecular changes can occur during the course of a patient’s metastatic disease as a response to treatment or sporadically, adds F. Anthony Greco, MD. As a result of this constant evolution, using CancerTREATMENT NGS+ at the time of recurrence makes sense, Greco suggests, to determine if there is now an actionable mutation that was not seen initially.