GENOMIC TESTING

During the <em>20th Annual </em>International Lung Cancer Congress, <em>Targeted Oncology</em> spoke with another Lung-MAP investigator, Fred R. Hirsch, MD, PhD, about the status and importance of the trial and new recommendations for molecular testing and liquid biopsies working their way into practice in the lung cancer field.

The FDA has approved entrectinib for the treatment of adult patients with <em>ROS1</em>-positive metastatic non&ndash;small cell lung cancer. An accelerated approval was also granted to entrectinib for the treatment of adult and adolescent patients with solid tumors harboring an <em>NTRK </em>gene fusion and who have no alternative, effective therapies available.

In the largest genomic study of Merkel cell carcinoma tumors to date, investigators identified 2 distinct molecular subgroups, an ultraviolet light&ndash;driven subtype and a viral-driven subtype, which matched with tumor mutational burden classifications.&nbsp;

Fred R. Hirsch, MD, PhD, shares a message with oncologists regarding molecular testing in patients with lung cancer. He says the most important message is that molecular characterization of the patient&rsquo;s tumor must be done in order to best treat the patient.

During an interview with <em>Targeted Oncology</em>, Charu Agarwal, MD, reviewed the findings of a prospective study of pembrolizumab monotherapy in patients with advanced NSCLC.

Tissue-based microsatellite instability testing showed high concordance for detection of cell-free DNA, according to the results of a <em>Clinical Cancer Research</em> analysis.

Next-generation sequencing has increasingly become more valuable to physicians treating cancer at academic medical centers, but these tests also need to be incorporated more into community oncology practices. A recent study, presented at the 2019 ASCO Annual Meeting, demonstrated that the use of these tests has increased in the community setting as the technology, and the use and approval of matched therapies, continues to develop.

In an interview with&nbsp;Targeted Oncology, Rodabe N. Amaria, MD, discussed the guidelines and recommendations outlined by the INMC. She also highlighted the importance of genomic testing in the neoadjuvant setting of melanoma.&nbsp;

In a data set of 292&nbsp;oncologists who responded to questions about current awareness and incorporation of molecular testing in the treatment of cancer, almost 69% incorrectly matched the molecular alteration with the appropriate targeted therapy.

Charu Aggarwal, MD, MPH, the Leslye M. Heisler Assistant Professor for Lung Cancer Excellence at Perelman School of Medicine, University of Pennsylvania, and other researchers conducted a prospective study using next-generation sequencing as a biomarker to predict response and progression-free survival rates in patients with non&ndash;small cell lung cancer &nbsp;receiving pembrolizumab monotherapy. The data were presented during the 2019 ASCO Annual Meeting.

In an interview with&nbsp;<em>Targeted Oncology</em>, Susan Branford, PhD discussed the current role of NGS testing in hematologic malignancies. Following her presentation at the 2019 EHA Congress, she addressed how NGS can be incorporated more into the community practice and what challenges must be overcome in order to make this happen.

Jurgen Wolf, MD, discusses the importance of broad genomic testing to identify alterations in patients with advanced non&ndash;small cell lung cancer (NSCLC). By identifying molecular alterations and driver mutations early on, patients can receive matched targeted therapies at a time in the course of disease when the treatments would have the greatest impact.

A study aimed at exploring genomic diversity and defining its associations with clinical outcomes in metastatic castration-resistant prostate cancer found that alterations in&nbsp;RB1&nbsp;were a potent predictor of poor survival and that other common aberrations may serve as prognostic indicators of treatment response, according to recent work published in the&nbsp;Proceedings of the National Academy of Sciences.

<em>FLT3</em> mutation analysis in laboratories has brought on reimbursement barriers in clinical oncology. Jordan Clark, chief commercial officer, Diaceutics, a diagnostic development and commercialization company, spoke to <em>Targeted Oncology</em> about the cause of reimbursement issues and how the problem affects all parties involved.

A new study shows comparability between liquid biopsy and tissue biopsy in both diagnostics and monitoring of non&ndash;small cell lung cancer (NSCLC). However, based on the results, liquid biopsies may be preferable to help oncologists make swifter decisions that help manage the disease.<br /> &nbsp;

Charles G. Mullighan, MBBS, MSc, MD, discussed with&nbsp;<em>Targeted Oncology&nbsp;</em>the role of genetic variants in understanding a patient&rsquo;s predisposition to ALL. He highlighted findings in research that may help in utilizing the current understanding of these genetic variants to make treatment decisions for patients with ALL.

Timothy F. Burns, MD, PhD, discusses the value of conducting next-generation sequencing in-house for patients with lung cancer compared with sending out to an external laboratory for molecular profiling results. Burns says he conducts NGS testing on all patients with metastatic and nonsquamous lung cancers. This includes patients that are both smokers and non-smokers.

A review of patients with advanced non&ndash;small cell lung cancer treated in a community practice setting demonstrated that not all patients recommended for receiving genomic testing are being appropriately tested for potential genetic drivers of disease.<br /> &nbsp;

The development and advancements in targeted therapies and immunotherapies have dramatically changed drug development and clinical practice. With access to widespread genomic research and next-generation sequencing, details about somatic and germline mutations in solid tumors can better inform the treatment plan,&nbsp;Howard &ldquo;Skip&rdquo; Burris III, MD, explains.

Olga K. Weinberg, MD, discusses how genomic testing has evolved over the years and how she envisions the role of NGS will change as more is learned about genetic mutations.&nbsp;

Jennifer Geurts, MS, CGC,&nbsp;discusses the current role of genetic testing, both in patients diagnosed with cancer, as well as family members that could be at risk of developing cancer. She also highlights how genetic counseling can impact treatment decisions in patients with pancreatic, breast, and ovarian cancers.

In the first precision oncology trial for pediatric patients with cancer, a larger percentage of patients than expected who underwent screening for targetable alterations in their tumors were able to be assigned to a treatment targeted to that alteration or pathway.

In an interview with&nbsp;<em>Targeted Oncology</em>, Banu Arun, MD, discussed the role of genetic testing in patients with metastatic breast cancer. She highlighted the importance of identifying various mutations, including&nbsp;<em>BRCA1/2&nbsp;</em>mutations in light of the approval of PARP inhibitors. In addition, she spoke to how the role of genomic testing is evolving in this field with the development of new targeted agents.

A new single-center report has found that the results of next-generation sequencing&ndash;based molecular profiling for non&ndash;GI stromal tumor sarcomas provided information used to effectively guide clinical management.

Significantly higher response rates were seen in patients with&nbsp;<em>ALK</em>-positive non&ndash;small cell lung cancer who had been treated with at least 1 prior ALK tyrosine kinase inhibitor &nbsp;before receiving lorlatinib and who harbored an&nbsp;<em>ALK&nbsp;</em>resistance mutation compared with those who did not have an&nbsp;<em>ALK&nbsp;</em>mutation.