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Inagaki C, Maeda D, Hatake K, Sato Y, Hashimoto K, Sakai D, Yachida S, Nonomura N, Satoh T. Clinical Utility of Next-Generation Sequencing-Based Panel Testing under the Universal Health-Care System in Japan: A Retrospective Analysis at a Single University Hospital. Cancers (Basel) 2021; 13:1121. [PMID: 33807840 PMCID: PMC7961835 DOI: 10.3390/cancers13051121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022] Open
Abstract
Next-generation sequencing (NGS) assay is part of routine care in Japan owing to its reimbursement by Japan's universal health-care system; however, reimbursement is limited to patients who finished standard treatment. We retrospectively investigated 221 patients who underwent Foundation One CDX (F1CDx) at our hospital. Every F1CDx result was assessed at the molecular tumor board (MTB) for treatment recommendation. Based on patients' preferences, presumed germline findings were also assessed at the MTB and disclosed at the clinic. In total, 204 patients underwent F1CDx and 195 patients completed the analysis; however, 13.8% of them could not receive the report due to disease progression. Among 168 patients who received the results, 41.6% had at least one actionable alteration, and 3.6% received genomically matched treatment. Presumed germline findings were nominated in 24 patients, and 16.7% of them contacted a geneticist counselor. The NGS assay should be performed earlier in the clinical course to maximize the clinical benefit. Broader reimbursement for the NGS assay would enhance the delivery of precision oncology to patients. Access to clinical trials affects the number of patients who benefit from NGS. Additionally, the disclosure of presumed germline findings is feasible in clinical practice.
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Affiliation(s)
- Chiaki Inagaki
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
| | - Daichi Maeda
- Department of Clinical Genomics, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
| | - Kazue Hatake
- Center for Cancer Genomics and Personalized Medicine, Osaka University Hospital, Osaka 565-0871, Japan; (K.H.); (D.S.); (S.Y.); (N.N.)
| | - Yuki Sato
- Department of Genetic Counseling, Osaka University Hospital, Osaka 565-0871, Japan; (Y.S.); (K.H.)
| | - Kae Hashimoto
- Department of Genetic Counseling, Osaka University Hospital, Osaka 565-0871, Japan; (Y.S.); (K.H.)
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Daisuke Sakai
- Center for Cancer Genomics and Personalized Medicine, Osaka University Hospital, Osaka 565-0871, Japan; (K.H.); (D.S.); (S.Y.); (N.N.)
| | - Shinichi Yachida
- Center for Cancer Genomics and Personalized Medicine, Osaka University Hospital, Osaka 565-0871, Japan; (K.H.); (D.S.); (S.Y.); (N.N.)
- Department of Cancer Genome Informatics, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Norio Nonomura
- Center for Cancer Genomics and Personalized Medicine, Osaka University Hospital, Osaka 565-0871, Japan; (K.H.); (D.S.); (S.Y.); (N.N.)
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
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Lazzari C, Bulotta A, Cangi MG, Bucci G, Pecciarini L, Bonfiglio S, Lorusso V, Ippati S, Arrigoni G, Grassini G, Doglioni C, Gregorc V. Next Generation Sequencing in Non-Small Cell Lung Cancer: Pitfalls and Opportunities. Diagnostics (Basel) 2020; 10:E1092. [PMID: 33333743 PMCID: PMC7765222 DOI: 10.3390/diagnostics10121092] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/19/2022] Open
Abstract
Lung cancer remains the first cause of cancer-related deaths worldwide. Thanks to the improvement in the knowledge of the biology of non-small cell lung cancer (NSCLC), patients' survival has significantly improved. A growing number of targetable molecular alterations have been identified. Next-generation sequencing (NGS) has become one of the methodologies entered in clinical practice and was recently recommended by the European society for medical oncology (ESMO) to perform a comprehensive molecular characterization in patients with cancer. The current review provides an overview of the clinical trials that have explored the impact of NGS in patients with cancer, its limits, and advantages.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Maria Giulia Cangi
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Gabriele Bucci
- Center for Omics Science, IRCCS San Raffaele, 20132 Milan, Italy; (G.B.); (S.B.)
| | - Lorenza Pecciarini
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Silvia Bonfiglio
- Center for Omics Science, IRCCS San Raffaele, 20132 Milan, Italy; (G.B.); (S.B.)
| | - Vincenza Lorusso
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Stefania Ippati
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Gianluigi Arrigoni
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Greta Grassini
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Claudio Doglioni
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
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Colomer R, Mondejar R, Romero-Laorden N, Alfranca A, Sanchez-Madrid F, Quintela-Fandino M. When should we order a next generation sequencing test in a patient with cancer? EClinicalMedicine 2020; 25:100487. [PMID: 32775973 PMCID: PMC7397394 DOI: 10.1016/j.eclinm.2020.100487] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/12/2020] [Accepted: 07/16/2020] [Indexed: 12/31/2022] Open
Abstract
Technical advances in genome sequencing and the implementation of next-generation sequencing (NGS) in clinical oncology have paved the way for individualizing cancer patient therapy based on molecular profiles. When and how to use NGS testing in the clinic is at present an unsolved issue, although new research results provide evidence favoring this approach in some types of advanced cancer. Clinical research is evolving rapidly, from basket and umbrella trials to adaptative design precision oncology clinical studies, and genomic and molecular data often displace the classical clinical validation procedures of biomarkers. In this context, physicians must be aware of the clinical evidence behind these new biomarkers and NGS tests available, in order to use them in the right moment, and with a critical point of view. This review will present the status of currently available targeted drugs that can be effective based on actionable molecular alterations, and the NGS tests that are currently available, offering a practical guide for the application of Clinical Precision Oncology in the real world routine practice.
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Affiliation(s)
- Ramon Colomer
- Departament of Medicine, Universidad Autónoma de Madrid (UAM), Spain
- Medical Oncology Division, Hospital Universitario La Princesa, Madrid, Spain
- Endowed Chair of Personalised Precision Medicine, Universidad Autónoma de Madrid (UAM)-Fundación Instituto Roche, Spain
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Rebeca Mondejar
- Departament of Medicine, Universidad Autónoma de Madrid (UAM), Spain
- Medical Oncology Division, Hospital Universitario La Princesa, Madrid, Spain
- Endowed Chair of Personalised Precision Medicine, Universidad Autónoma de Madrid (UAM)-Fundación Instituto Roche, Spain
| | - Nuria Romero-Laorden
- Medical Oncology Division, Hospital Universitario La Princesa, Madrid, Spain
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | | | - Francisco Sanchez-Madrid
- Departament of Medicine, Universidad Autónoma de Madrid (UAM), Spain
- Endowed Chair of Personalised Precision Medicine, Universidad Autónoma de Madrid (UAM)-Fundación Instituto Roche, Spain
- Immunology Division, Hospital Universitario La Princesa, Madrid, Spain
| | - Miguel Quintela-Fandino
- Departament of Medicine, Universidad Autónoma de Madrid (UAM), Spain
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
- Medical Oncology Division, Hospital Universitario Quirón, Pozuelo de Alarcón – Madrid, Spain
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Bedard PL, Hyman DM, Davids MS, Siu LL. Small molecules, big impact: 20 years of targeted therapy in oncology. Lancet 2020; 395:1078-1088. [PMID: 32222192 DOI: 10.1016/s0140-6736(20)30164-1] [Citation(s) in RCA: 260] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/13/2022]
Abstract
The identification of molecular targets and the growing knowledge of their cellular functions have led to the development of small molecule inhibitors as a major therapeutic class for cancer treatment. Both multitargeted and highly selective kinase inhibitors are used for the treatment of advanced treatment-resistant cancers, and many have also achieved regulatory approval for early clinical settings as adjuvant therapies or as first-line options for recurrent or metastatic disease. Lessons learned from the development of these agents can accelerate the development of next-generation inhibitors to optimise the therapeutic index, overcome drug resistance, and establish combination therapies. The future of small molecule inhibitors is promising as there is the potential to investigate novel difficult-to-drug targets, to apply predictive non-clinical models to select promising drug candidates for human evaluation, and to use dynamic clinical trial interventions with liquid biopsies to deliver precision medicine.
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Affiliation(s)
- Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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