The European Society for Medical Oncology (ESMO) has issued a set of recommendations on the use of next-generation sequencing (NGS) for patients with metastatic cancers.1
“These are the first recommendations from a scientific society about the use of NGS,” Fernanda Mosele, MD, first author of the recommendations paper and medical oncologist at Gustave Roussy in Villejuif, France, said in a press release.2 “Our intent is that they will unify decision-making about how NGS should be used for patients with metastatic cancer.”
Published in the Annals of Oncology, the recommendations were developed by the ESMO Translational Research and Precision Medicine Working Group on the basis of the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT) ranking for genomic alterations occurring in the 8 cancers responsible for the most deaths worldwide. Specifically, experts used the ESCAT ranking and prevalence of alterations within each tumor type to determine the number of patients that would need to be tested with NGS to identify 1 patient who could be matched to an effective drug in regular practice.
Overall, ESMO suggests that NGS should be routinely used in patients with advanced lung adenocarcinoma, prostate cancer, ovarian cancer, and cholangiocarcinoma. For patients with other cancers, ESMO indicated that patients could decide together with their doctor whether or not to order NGS – provided there is no extra cost for the public healthcare system and the patient is informed about the relative likelihood of benefit.
“This recommendation acknowledges that a small number of patients could benefit from a drug because they have a rare mutation,” co-author Joaquin Mateo, chair of the ESMO Translational Research and Precision Medicine Working Group and group leader of Prostate Cancer Translational Research from the Vall d’Hebron Institute of Oncology (VHIO) in Barcelona, Spain, said in the release. “When an alteration is uncommon, it will be difficult to gather enough patients in research studies to generate the evidence necessary for using NGS. So, beyond the cancers in which everyone should receive NGS, there is room for physicians and patients to discuss the pros and cons of ordering these tests.”
In addition to the above recommendations, ESMO recommended that clinical research centers perform NGS to bring about more evidence regarding the use of this method and to also accelerate drug development. Further, given that current evidence of the cost-effectiveness of using NGS testing regularly is weak, the organization suggested economic evaluations alongside clinical trials also be implemented.
“ESMO is calling on university hospitals and research institutions to generate data and make it accessible to advance innovation. This will enable us to learn how best to use this technology in other tumor types,” Mateo noted. “However, we cannot forget that sometimes cancers change over time as they adapt to new therapies. So, we have to balance testing a lot of alterations at the beginning with being aware that some of them may change over time.”
Importantly, these recommendations will need to be updated regularly following the emergence of new data for novel therapies across tumor types.
“This paper highlights how difficult it is to move precision medicine approaches from research into everyday clinical practice. For example, we need to address the issue of rare cancer subtypes or biomarkers more common in specific populations that may be underrepresented,” Mateo concluded. “ESMO is committed to bridging the gap between research and practice by providing evidence-based guidance on the use of NGS that leads to equal access to the best care for all patients with cancer.”
1. Mosele 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. Annals of Oncology. doi: 10.1016/j.annonc.2020.07.014.
2. ESMO issues first recommendations on using next-generation sequencing for advanced cancers [news release]. Lugano, Switzerland. Published August 25, 2020. Accessed August 25, 2020.