The promise of 1-day in-house NGS in every cancer center

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.

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Challenging the Cancer Treatment Paradigm

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.

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How the Current Paradigm Negatively Affects Patient Care

Recent data shows that roughly 70% of cancer drugs in the development pipeline are targeted therapies¹. Yet as targeted treatments become more widely available, multi-biomarker analysis has lagged. NGS testing in many hospitals can take up to 3-4 weeks when sending samples out to third-party labs, limiting these therapies to second-line or later options as clinicians need to initiate an intervention plan as soon as possible.

Initial Diagnosis (1-2 weeks)

Limited single-gene testing

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)

Begin non-targeted therapy. If progression occurs, outsource NGS testing.

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)

Potentially poor clinical outcome

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.

A Potential New In-House NGS Diagnostic and Treatment Paradigm

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.

In-house daily NGS with a comprehensive panel

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)

Begin targeted therapy

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)

Improved clinical outcome

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.

Post-Treatment Outcome

Realizing the promise of precision oncology for all patients

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.

Workflow automation

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.

Simplified reporting

Integrated reporting tools now quickly identify and annotate genetic variants using the latest insight about approved therapies, medical guidelines, and clinical trials. This reduces the need for advanced bioinformatics expertise and allows clinicians to quickly receive a comprehensive, actionable report.

Faster time to consultation

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.

Tissue preservation

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.

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Increased testing success rate

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.

Reduced risk for patients

NGS tests requiring less sample input will reduce the risk of rebiopsy and save patient suffering by decreasing side effects, clinical operations, and hospitalization.

Hospital economics of in-house NGS

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.

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Ready to Discuss Options for Bringing NGS In-House?

References:

1. THE PERSONALIZED MEDICINE REPORT; Personalized Medicine Coalition,http://www.personalizedmedicinecoalition.org/Userfiles/PMC-Corporate/file/The-Personalized-Medicine-Report1.pdf