Strategies for the successful implementation of plasma-based NSCLC genotyping in clinical practice.
Charu AggarwalChristian C RolfoGeoffrey R OxnardJhanelle E GrayLynette M ShollDavid R GandaraPublished in: Nature reviews. Clinical oncology (2020)
Upfront tumour genotyping is now considered an essential step in guiding treatment decision-making in the management of patients with advanced-stage non-small-cell lung cancer (NSCLC) in light of the ever-expanding toolbox of targeted therapies and immune-checkpoint inhibitors. However, genotyping of tumour biopsy samples is not feasible for all patients and, therefore, genomic analysis of circulating tumour DNA (ctDNA) has emerged as a compelling non-invasive option. Current guidelines universally recommend genotyping and support the use of ctDNA testing in certain settings, although they often omit the detail necessary for integrating these tests into clinical care on an individual basis. In this Perspective, we describe the rationale, promise and challenges associated with ctDNA-based NSCLC genotyping and suggest a framework for the implementation of these assays into routine clinical practice. We also offer considerations for the interpretation of ctDNA genotyping results, which, particularly when using next-generation sequencing panels, can be nuanced. Through the addition of this new approach to clinical practice, we propose that oncologists might finally be able to utilize effective genotyping in nearly all patients with advanced-stage NSCLC.
Keyphrases
- clinical practice
- high throughput
- circulating tumor
- genome wide
- small cell lung cancer
- genetic diversity
- healthcare
- advanced non small cell lung cancer
- primary care
- quality improvement
- cell free
- end stage renal disease
- palliative care
- circulating tumor cells
- dna methylation
- newly diagnosed
- brain metastases
- single cell
- ejection fraction
- chronic pain
- big data
- peritoneal dialysis
- artificial intelligence
- machine learning
- combination therapy
- replacement therapy
- fine needle aspiration
- ultrasound guided
- affordable care act