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Delivering Precise Immunotherapy With NGS in NSCLC

Charu Aggarwal, MD, MPH
Published Online:7:48 PM, Wed July 17, 2019

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 (NGS) as a biomarker to predict response and progression-free survival rates in patients with non–small cell lung cancer (NSCLC) receiving pembrolizumab (Keytruda) monotherapy. The data were presented during the 2019 ASCO Annual Meeting.

How a circulating tumor DNA (ctDNA) NGS profile and serial and ctDNA NGS monitoring relates to patient response after pembrolizumab monotherapy in patients with NSCLC is unclear because of limited data. In the study, researchers gathered some of the missing data by collecting plasma at baseline, 9 weeks into treatment, and at 18 weeks into treatment. The NGS gene panel could detect 73 mutations in study patients.

For applying these data to clinical practice, Aggarwal says monitoring to see whether or not patients’ variant allele fraction(VAF) is high or low at 9 weeks and 18 weeks can give physicians more detail, so they know whether they need to add chemotherapy to the pembrolizumab treatment or not. Patients with an increasing VAF may benefit from the addition of chemotherapy to pembrolizumab, while those with a decreasing VAF can continue with pembrolizumab monotherapy. Overall, NGS is a way to amplify therapy for NSCLC and deliver more precise, personalized care, says Aggarwal. 
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