1. Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: a report from the ESMO Precision Medicine Working Group
- Author
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Aldo Scarpa, Albrecht Stenzinger, Nikhil Wagle, F. Mosele, S. Jezdic, A. Bayle, Fabrice Barlesi, Etienne Rouleau, Funda Meric-Bernstam, J.-Y. Douillard, Joaquin Mateo, Ivan Bièche, Julia Bonastre, Fabrice Andre, Jordi Remon, Stefan Michiels, Jorge S. Reis-Filho, Martijn P. Lolkema, Mark E. Robson, Nicola Normanno, C. B. Westphalen, R. Dienstmann, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Prédicteurs moléculaires et nouvelles cibles en oncologie (PMNCO), Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, and Medical Oncology
- Subjects
Male ,0301 basic medicine ,Oncology ,medicine.medical_specialty ,Lung Neoplasms ,[SDV]Life Sciences [q-bio] ,Genomics ,Pembrolizumab ,Medical Oncology ,DNA sequencing ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Next-generation sequencing (NGS) ,genomic alterations ,metastatic cancers ,Carcinoma, Non-Small-Cell Lung ,Internal medicine ,medicine ,Humans ,Precision Medicine ,Lung cancer ,business.industry ,High-Throughput Nucleotide Sequencing ,Hematology ,medicine.disease ,Precision medicine ,3. Good health ,Clinical trial ,030104 developmental biology ,Clinical research ,Drug development ,030220 oncology & carcinogenesis ,business - Abstract
Next-generation sequencing (NGS) allows sequencing of a high number of nucleotides in a short time frame at an affordable cost. While this technology has been widely implemented, there are no recommendations from scientific societies about its use in oncology practice. The European Society for Medical Oncology (ESMO) is proposing three levels of recommendations for the use of NGS. Based on the current evidence, ESMO recommends routine use of NGS on tumour samples in advanced non-squamous non-small-cell lung cancer (NSCLC), prostate cancers, ovarian cancers and cholangiocarcinoma. In these tumours, large multigene panels could be used if they add acceptable extra cost compared with small panels. In colon cancers, NGS could be an alternative to PCR. In addition, based on the KN158 trial and considering that patients with endometrial and small-cell lung cancers should have broad access to anti-programmed cell death 1 (anti-PD1) antibodies, it is recommended to test tumour mutational burden (TMB) in cervical cancers, well- and moderately-differentiated neuroendocrine tumours, salivary cancers, thyroid cancers and vulvar cancers, as TMB-high predicted response to pembrolizumab in these cancers. Outside the indications of multigene panels, and considering that the use of large panels of genes could lead to few clinically meaningful responders, ESMO acknowledges that a patient and a doctor could decide together to order a large panel of genes, pending no extra cost for the public health care system and if the patient is informed about the low likelihood of benefit. ESMO recommends that the use of off-label drugs matched to genomics is done only if an access programme and a procedure of decision has been developed at the national or regional level. Finally, ESMO recommends that clinical research centres develop multigene sequencing as a tool to screen patients eligible for clinical trials and to accelerate drug development, and prospectively capture the data that could further inform how to optimise the use of this technology.
- Published
- 2020