KUALA LUMPUR, Jan 15 — In the battle against cancer, timely intervention is crucial. The growing number of biomarkers linked to targeted therapies has brought increased optimism for patients in the recent decade.
However, there are still gaps in the implementation of personalised medicine, the process of delivering genomic profile data to oncologists remains imperfect, creating barriers for patients to access potentially beneficial treatments2.
In fact, the number of molecular biomarkers relevant for precision oncology research has also been growing rapidly, and in many cases, sequential single-gene testing methods have proven to be insufficient and inefficient2. Fortunately, technology has advanced in parallel so that hospitals can easily bring highly automated NGS in-house to benefit patients, maximise efficiency and minimise costs3.
NGS is a type of molecular testing technology that has revolutionised genomics by enabling rapid sequencing of a large number of genes simultaneously from a single test1.
Hospitals in Malaysia can now choose to implement rapid NGS technology in-house, instead of outsourcing to specialised reference laboratories that could be more expensive and take longer turnaround times. With some of the available rapid in-house NGS solutions in the market, results are now possible in as little as 24 hours, allowing for quicker decision-making and timely initiation of optimised and targeted treatment therapies for cancer patients3.
Use Lesser Tissue Samples For More Actionable Biomarker Insights
Modern cancer care relies heavily on biomarker testing for diagnosis and therapy. As the number of actionable biomarkers continues to increase, single or sequential biomarker testing may no longer be the most practical solution2.
Traditionally, single gene testing methods can rapidly deplete precious tissue samples, drive up cost, and increase time to results for all actionable biomarkers being tested4. A single multi-gene NGS test may require a lesser amount of tissue compared to multiple rounds of single-gene testing, in which a tissue sample is needed for each test. Sequential single-gene testing can also cost as much or even more than a NGS multigene assay5.
Especially for scarce biopsied samples that are difficult to retrieve, multiple tests may not be possible if testing doesn’t get it right the first time5. In comparison, with parallel sequencing of multiple genes, multigene NGS assays could mean more patients can be successfully tested more rapidly, without the need for re-biopsies.
In fact, advancements in bioinformatics and reporting capabilities have made it easier for clinicians to access easy to understand and vital information (including tumour mutational burden annotations), allowing for contextual investigation of sample-specific variants with respect to labels, guidelines, current clinical trials, and peer-reviewed literature.
Studies Show Better Cancer Survival Rates With Rapid NGS Genomic Profiling
Limited single-gene testing, followed by outsourced NGS testing, often leads to extended delays for results, sometimes up to 33 days6. In some cases, oncologists must start patients on conventional therapies while they await the molecular report, which can lead to suboptimal outcomes.
Gaining access to timely genomic testing can significantly improve patient outcomes and survival. A real-world study by JA Scott et. al, presented at the 2023 American Society of Clinical Oncology (ASCO) annual meeting, showed a 95 per cent median overall survival rate in cancer cases with genomic testing results7.
In a separate Integra study of 525 non-small cell lung cancer (NSCLC) cases, patients who underwent biomarker testing and were treated with a biomarker-directed first-line treatment with a tyrosine kinase inhibitor (TKI) showed6:
- Up to 35 per cent higher survival probability after two years, than those who were put on a first-line chemotherapy and/or immunotherapy regimen in the absence of genomic profiling results6.
- 22 per cent higher survival probability after two years, relative to patients who were initially on a first-line chemotherapy and/or immunotherapy regimen and later switched to second-line TKI therapy after genomic profiling results were made available6.
These findings suggest that access to timely genomic profile results could provide clinicians the opportunity to choose optimal first-line therapy for those patients whose tumours harbour actionable genomic alterations.
True Personalised Medicine From Multidisciplinary Care, Shorter Time To Diagnosis And Treatment
With sample and testing expertise on-site, in-house NGS testing allows multidisciplinary teams in hospitals to have improved care coordination and tailor patient treatments for better outcomes8.
By providing detailed genomic data with a single test, rapid NGS helps avoid one-size-fits-all treatments. Patients can receive the most effective, tailored therapies from the onset.
A reduction in time to diagnosis may also cut hospital stay duration, translating to cost savings for both patients and the health care system, besides freeing up hospital beds for others.
The democratisation of NGS is one of the cornerstones to accelerating cancer care in Malaysia. With available technology, there is little reason why patients should have to wait weeks or months for their test results, compromising their access to an optimal treatment regime.
Today, the science has matured, the technology is easy to implement, and more hospitals are now bringing NGS testing in-house to benefit patients8. Rapid in-house NGS can benefit both clinicians and patients with shorter time to treatment, more effective personalised care to optimise clinical outcomes. Let’s work together to transform patient care in Malaysia today!
References
- Sheffield, B. S. et al (2022). Point of Care Molecular Testing: Community-Based Rapid Next-Generation Sequencing to Support Cancer Care. Current Oncology 29(3),1326-1334. Link here.
- Sadik, H. et al (2022). Impact of Clinical Practice Gaps on the Implementation of Personalized Medicine in Advanced Non–Small-Cell Lung Cancer. JCO Precision Oncology. Link here.
- Ilié, M. et al (2022). Cancers (Basel) 14(9), 2258. Link here.
- Sivakumar, A. (2020, July 22). Tissue is still the issue. The Pathologist. Link here.
- Hamblin A, Wordsworth S, Fermont JM, Page S, Kaur K, Camps C, Kaisaki P, Gupta A, Talbot D, Middleton M, Henderson S, Cutts A, Vavoulis DV, Housby N, Tomlinson I, Taylor JC, Schuh A. Clinical applicability and cost of a 46-gene panel for genomic analysis of solid tumours: Retrospective validation and prospective audit in the UK National Health Service. PLoS Med. 2017 Feb 14;14(2):e1002230. doi: 10.1371/journal.pmed.1002230.
- Smith, R.E. et al (2022). Evaluation of outcomes in patients (pts) with stage 4 non-small cell lung cancer (NSCLC 4) harboring actionable oncogenic drivers (AOD) when treated prior to report of mutation without tyrosine kinase inhibitors (TKI): An Integra Connect Database (ICD) retrospective observational study. Journal of Clinical Oncology. Link here.
- JA Scott et al., “Real-world testing and treatment patterns among patients with stage IV non-small cell lung cancer: A retrospective observational study,” Poster presented at the 2023 ASCO Annual Meeting May 31–June 4; Chicago, USA. 9030.
- European Society for Medical Oncology. (n.d.). An in-house home for precision oncology [Ebook]. Link here.
