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Precision Oncology: Who, How, What, When, and When Not?
Lee Schwartzberg1, Edward S Kim1, David Liu1
1From the University of Tennessee Health Science Center, Memphis, TN; Levine Cancer Institute, Charlotte, SC; Dana-Farber Cancer Institute, Boston, MA.
Abstract:
Precision oncology, defined as molecular profiling of tumors to identify targetable alterations, is rapidly developing and has entered the mainstream of clinical practice. Genomic testing involves many stakeholders working in a coordinated fashion to deliver high-quality tissue samples to high-quality laboratories, where appropriate next-generation sequencing (NGS) molecular analysis leads to actionable results. Clinicians should be familiar with the types of genomic variants reported by the laboratory and the technology used to determine the results, including limitations of current testing methodologies and reports. Interpretation of genomic results is best undertaken with multidisciplinary input to reduce uncertainty in clinical recommendations relating to a documented variant. Non-small cell lung cancer has emerged as a prototype disease where genomic data from at least several well-documented alterations with approved targeted agents are essential for optimal treatment from diagnosis of advanced disease. Due to the development of resistance to targeted therapies, resampling and retesting of tumors, including using liquid biopsy technology after clinical progression, may be important in making treatment decisions. The value of molecular profiling depends on avoiding both underutilization for well-documented variant target-drug pairs and overutilization of variant-drug therapy without proven benefit. As techniques evolve and become more cost effective, the use of molecular testing may prove to add more specificity and improve outcomes for a larger number of patients.
Insights
Precision oncology uses molecular profiling to find targetable tumor alterations. Genomic testing, including next-generation sequencing, guides targeted therapies, especially in non-small cell lung cancer, improving patient outcomes.
Area of Science:
- Oncology
- Genomics
- Molecular Biology
Background:
- Precision oncology, or molecular tumor profiling, is increasingly integrated into clinical practice.
- Genomic testing requires collaboration among stakeholders to ensure high-quality tissue samples and accurate next-generation sequencing (NGS) analysis.
- Clinicians must understand genomic variant types, NGS technology, and its limitations.
Purpose of the Study:
- To review the current landscape of precision oncology and genomic testing.
- To highlight the importance of multidisciplinary interpretation of genomic results for clinical decision-making.
- To discuss the role of molecular profiling in non-small cell lung cancer (NSCLC) and the implications of treatment resistance.
Main Methods:
- Literature review and synthesis of current practices in precision oncology.
- Discussion of next-generation sequencing (NGS) methodologies and interpretation challenges.
- Case example of non-small cell lung cancer (NSCLC) to illustrate genomic-guided treatment.
Main Results:
- Genomic data is crucial for optimal treatment of advanced non-small cell lung cancer (NSCLC).
- Resampling and retesting tumors, including liquid biopsies, are important after progression to guide subsequent treatment.
- Appropriate utilization of molecular profiling is key to maximizing its value and avoiding under- or over-treatment.
Conclusions:
- Precision oncology offers significant potential to improve patient outcomes through targeted therapies.
- Multidisciplinary input is essential for accurate interpretation and clinical application of genomic findings.
- Continued evolution of genomic techniques and cost-effectiveness will expand the use of molecular testing in oncology.
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