Professor Fabrice André
Previous Chair of the ESMO Translational Research and Precision Medicine Working Group, Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France.
Pioneering new guidelines on multigene next-generation sequencing are bringing innovative treatments to patients with cancer.
Novel technologies now make it possible to sequence hundreds or even thousands of genes in a short time frame. Treatment can be selected according to the genomic alterations in a tumour. The European Society for Medical Oncology (ESMO) has led the way in publishing recommendations on the use of multigene next-generation sequencing (NGS), providing practical advice for cancer centres on the value of this technology to deliver precision medicine1.
Use NGS for certain cancers
ESMO recommends the use of multigene NGS in patients with some advanced cancers – for example, lung, prostate, and ovarian cancer. This is the first advice from a scientific society and a huge step forward for these patients.
Enrol patients in clinical trials
Participation in clinical trials can be a route to innovative treatments. ESMO recommends that clinical research centres offer multigene NGS to patients with cancer as part of their mission to enable access to novel therapies.
In addition to giving more treatment options, this approach generates much needed evidence on the use of this technology in other tumour types. It also accelerates development of drugs targeting specific mutations.
Patients need to be made aware that finding a previously unidentified mutation by examining a large panel of genes is uncommon.
Patients at the centre
Individual patients can have an outlier response to extremely rare and unexpected, potentially clinically useful, genomic alterations. While this is likely a very small percentage of patients, ESMO acknowledges that patients and their clinicians should have the option to order a multigene sequencing test provided there is no cost to the public healthcare system.
Patients need to be made aware that finding a previously unidentified mutation by examining a large panel of genes is uncommon. But ESMO believes that patients and their doctors should have the freedom to decide to investigate the possibility.
ESMO developed the recommendations based on the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT) ranking for genomic alterations occurring in eight cancers. Experts used the ESCAT ranking and prevalence of alterations to calculate the number of patients that would need to be tested with NGS to identify one patient who could be matched to an effective drug in daily practice.
1Mosele F, Remon J, Mateo J, et al. Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: a report from the ESMO Precision Medicine Working Group. Ann Oncol. 2020 Aug 24:S0923-7534(20)39971-3. doi: 10.1016/j.annonc.2020.07.014.