Imagine a future where every cancer patient can receive a genomic profile in time for their oncologist to consider all relevant biomarkers when choosing a first-line treatment. We aren’t there yet, but we’re getting closer. Let’s explore how that future might look and what's required to get there.
NGS technology advancements are bringing new possibilities to the future of cancer care. As the speed of molecular testing results increases, oncologists could soon have earlier insight about cancer genomic drivers, enabling them to make the most appropriate first-line treatment decision. Dr. Luca Quagliata shares his perspective about a potential shift in the current diagnostic and treatment paradigm.
Initial Diagnosis (1-2 weeks)
Single-gene tests (e.g. EGFR and ALK) can be returned within a few days, but provide limited insight about the ideal course of therapy. These tests can miss critical mutations affecting the therapy selection decision.
1st Line Treatment (3-10 weeks)
If the single-gene tests do not yield a positive result, the patient is often started on a non-targeted and potentially sub-optimal therapy. An NGS test is then ordered, provided that enough sample material still remains.
2nd Line Treatment (10-16 weeks)
Only once the first-line treatment cycle is complete can the clinician consider a second-line targeted therapy based on the NGS test results. This can take up to 16 weeks, during which time the patient condition may deteriorate, leading to poorer clinical outcomes.
In order for targeted therapies to become more common first-line options, a comprehensive gene panel must become available in the same time frame as single-biomarker testing methods such as immunohistochemistry. With all relevant genetic insights available so quickly, clinicians will be enabled to choose among more therapeutic options.
During the initial diagnosis phase, an NGS test is ordered along with standard single-biomarkers like PD-L1 from the tissue or a liquid biopsy.
Initial Diagnosis (1st week)
A complete, relevant report can be provided in under a week, allowing the clinician to potentially start a patient on the most appropriate first-line therapy.
1st Line Treatment (2nd week)
Targeted therapies can lead to better clinical outcomes, as the patient is put on the right course of treatment much earlier based on their specific genomic makeup.
Someday the promise of precision oncology will be fully realized with access to timely and comprehensive cancer profiles for all patients. This paradigm shift can only occur if more hospitals are able to bring the technology in-house. NGS testing solutions need to be practical for any hospital to implement with their existing staff and resources. Here are some of the ways that NGS advancements are helping to shape the future of cancer care for hospitals.
Fast and comprehensive results from local laboratories
Clinicians need earlier and more comprehensive insight about all relevant genomic cancer drivers to make the most informed and appropriate first-line treatment decisions.
In-house NGS testing is no longer the domain of just the leading academic institutions. Thanks to advancements in workflow automation, in-house laboratories no longer need to invest in extensive training for their personnel. It is easier and more cost-effective than ever for community hospital labs to get started.
Integrated reporting tools now quickly identify and annotate biomarkers with relevant evidence. This reduces the need for advanced bioinformatics expertise and allows clinicians to quickly receive a comprehensive, actionable report.
By speeding up the time to results through in-house NGS testing, hospitals can reduce the clinical deterioration risk, an issue observed in up to 20% of advanced stage cancers within the first weeks.
Maximized use of every patient sample
Small and sometimes low-quality samples are the reality in a routine clinical setting. It's necessary to use tests that do not require large sample amounts and can yield maximum information.
Some NGS tests require as little as 10ng of sample input, meaning NGS can be performed along with other standard assays from the same biopsy without depleting precious tissue samples.
Because a lower input requirement leads to higher success rates, more patients can be treated or givien options to join ongoing clinical trials. Currently, many patients either receive QNS (quantity not sufficient) test results, or go untested altogether due to lack of tissue availability.
NGS tests requiring less sample input will reduce the risk of rebiopsy and save patient suffering by decreasing side effects, clinical operations, and hospitalization.
As NGS testing continues to become more prevalent in hospitals, the economic benefits are increasingly clear for these institutions. From increased patient retention and patient volume to reduced operating costs, there are a number of ways in-house NGS creates value.