Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: A report from the ESMO Precision Medicine Working Group

F Mosele, J Remon, J Mateo, C B Westphalen, F Barlesi, M P Lolkema, N Normanno, A Scarpa, M Robson, F Meric-Bernstam, N Wagle, A Stenzinger, J Bonastre, A Bayle, S Michiels, I Bièche, E Rouleau, S Jezdic, J-Y Douillard, J Reis-Filho, R Dienstmann, F André
Annals of Oncology: Official Journal of the European Society for Medical Oncology 2020 July 28
Next-generation sequencing (NGS) allows sequencing a high number of nucleotides in a short time frame at an affordable cost. While this technology has been widely implemented, there are no recommendations from scientific societies about their use in oncology practice. The European Society for Medical Oncology (ESMO) is proposing three levels of recommendations for the use of NGS. Based on the current evidence, ESMO recommends routine use of NGS on tumour samples in advanced non-squamous NSCLC, prostate cancers, ovarian cancers and cholangiocarcinoma. In these tumours, large multigene panels could be used if they add acceptable extra cost compared to small panels. In colon cancers, NGS could be an alternative to polymerase chain reaction (PCR). In addition, based on KN158 trial and considering that patients with endometrial and small cell lung cancers should have broad access to anti-PD1 antibodies, it is recommended to test tumour mutational burden (TMB) in cervical cancers, well- and moderately-differentiated neuroendocrine tumours, salivary cancers, thyroid and vulvar cancers, as TMB-high predicted response to pembrolizumab in these cancers. Outside the indications of multigene panels, and considering that the use of large panel of genes could lead to few clinically meaningful responders, ESMO acknowledges that a patient and a doctor could decide together to order a large panel of genes, pending no extra cost for the public healthcare system and if the patients is informed about the low likelihood of benefit. ESMO recommends that the use of off-label drugs matched to genomics is done only if an access programme and a procedure of decision has been developed at the national or regional level. Finally, ESMO recommends that clinical research centres develop multigene sequencing as a tool to screen patients eligible for clinical trials and to accelerate drug development, and prospectively capture the data that could further inform how to optimise the use of this technology.

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