11- 13 As a result, one or more rebiopsies may be needed to complete the sequence. 10 In either case, running a sequence of single-gene tests can be time consuming and may require a relatively large tissue sample, which is not always available as NSCLC is often detected at an advanced stage and only small biopsy samples are usually attainable. 10 Sequences of single-gene tests can also be used without hotspot panel, typically testing for the most common alterations first and less common alterations last. 10 In the case of negative results, the panel is generally followed by a sequence of single-gene tests for less common alterations. Frequently, a hotspot panel is used to test patients for a handful of common genomic alterations. 2, 9 Currently, a number of testing strategies are available with which to identify genomic alterations in NSCLC. Targeted therapies have been demonstrated to significantly improve treatment response and progression-free survival 7- 9 therefore, it is important to identify patients with specific genomic alterations to individualize treatment and optimize outcomes. Stakeholders should consider moving to NGS as the preferred method for biomarker testing. Our model illustrates that moving from sequential single-gene tests or even panels of tests to broader NGS testing for patients with advanced NSCLC is already the best strategy in these three areas and will only become more relevant as the list of tests grows. Upfront NGS testing also results in the largest number of patients with targetable genetic alterations being identified in the shortest period of time.Īs more clinically relevant genetic targets in NSCLC emerge that require routine testing at diagnosis, it is vital to identify the molecular testing strategy that is timeliest, spares the most tissue, and is most cost efficient, as this must be done in every new patient. Upfront next-generation sequencing (NGS) testing for all relevant molecular targets in NSCLC is less costly than performing single-gene testing, no matter what testing strategy is used. To determine the least costly strategy for testing for all recommended molecular abnormalities in patients with non–small-cell lung cancer (NSCLC) at diagnosis.
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