Comparison of Sequential Testing and Next Generation Sequencing in advanced Lung Adenocarcinoma patients – A single centre experience

Dall’Olio, Filippo Gustavo; Conci, Nicole; Rossi, Giulio; Fiorentino, Michelangelo; Giglio, Andrea De; Grilli, Giada; Altimari, Annalisa; Gruppioni, Elisa; Filippini, Daria Maria; Federico, Alessandro Di; Nuvola, Giacomo; Ardizzoni, Andrea

doi:10.1016/j.lungcan.2020.08.008

Cited by 25 publications

(21 citation statements)

References 23 publications

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“…The unprecedented results of immune checkpoint inhibitors (ICIs) have rapidly changed the therapeutic scenario in patients with advanced Non-Small Cell Lung Cancer (NSCLC), becoming standard of care both alone and in combination with chemotherapy in first and further lines of treatment 1 for patients with non-oncogene addicted NSCLC, that represents the majority of lung cancer cases in western populations. 2 A number of randomized studies have demonstrated that ICIs prolong median OS of, as an average, 2-4 months as compared to standard docetaxel-based chemotherapy in patients with advanced pre-treated NSCLC, with a 5-year…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Monitoring tumor growth rate to predict immune checkpoint inhibitors’ treatment outcome in advanced NSCLC

et al. 2022

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Introduction: Radiological response assessment to immune checkpoint inhibitor is challenging due to atypical pattern of response and commonly used RECIST 1.1 criteria do not take into account the kinetics of tumor behavior. Our study aimed at evaluating the tumor growth rate (TGR) in addition to RECIST 1.1 criteria to assess the benefit of immune checkpoint inhibitors (ICIs). Methods: Tumor real volume was calculated with a dedicated computed tomography (CT) software that semi-automatically assess tumor volume. Target lesions were identified according to RECIST 1.1. For each patient, we had 3 measurement of tumor volume. CT-1 was performed 8–12 weeks before ICI start, the CT at baseline for ICI was CT0, while CT + 1 was the first assessment after ICI. We calculated the percentage increase in tumor volume before (TGR1) and after immunotherapy (TGR2). Finally, we compared TGR1 and TGR2. If no progressive disease (PD), the group was disease control (DC). If PD but TGR2 < TGR1, it was called LvPD and if TGR2 ⩾ TGR1, HvPD. Results: A total of 61 patients who received ICIs and 33 treated with chemotherapy (ChT) were included. In ICI group, 18 patients were HvPD, 22 LvPD, 21 DC. Median OS was 4.4 months (95% CI: 2.0–6.8, reference) for HvPD, 7.1 months (95% CI 5.4–8.8) for LvPD, p = 0.018, and 20.9 months (95% CI: 12.5–29.3) for DC, p < 0.001. In ChT group, 7 were categorized as HvPD, 17 as LvPD and 9 as DC. No difference in OS was observed in the ChT group (p = 0.786) Conclusion: In the presence of PD, a decrease in TGR may result in a clinical benefit in patients treated with ICI but not with chemotherapy. Monitoring TGR changes after ICIs administration can help physician in deciding to treat beyond PD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Monitoring tumor growth rate to predict immune checkpoint inhibitors’ treatment outcome in advanced NSCLC

et al. 2022

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“…While a minority of patients have a willingness to pay, there are benefits to all public taxpayers for these technologies to be funded and thus provide equitable access to genomics to derive improvements in population outcomes. From a payer perspective, the use of NGS panels is less expensive, more reliable, and requires less tissue samples than sequential testing in NSCLC [ 40 , 41 ]. In an Italian study, costs were EUR 1375/patient for sequential testing compared to EUR 770/patient for NGS [ 40 ], and significant savings for payers have also been reported [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Patient and Clinician Preferences for Genetic and Genomic Testing in Non-Small Cell Lung Cancer: A Discrete Choice Experiment

Fifer¹,

Ordman²,

Briggs

et al. 2022

JPM

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Precision (personalised) medicine for non-small cell lung cancer (NSCLC) adopts a molecularly guided approach. Standard-of-care testing in Australia is via sequential single-gene testing which is inefficient and leads to tissue exhaustion. The purpose of this study was to understand preferences around genetic and genomic testing in locally advanced or metastatic NSCLC. A discrete choice experiment (DCE) was conducted in patients with NSCLC (n = 45) and physicians (n = 44). Attributes for the DCE were developed based on qualitative interviews, literature reviews and expert opinion. DCE data were modelled using a mixed multinomial logit model (MMNL). The results showed that the most important attribute for patients and clinicians was the likelihood of an actionable test, followed by the cost. Patients significantly preferred tests with a possibility for reporting on germline findings over those without (β = 0.4626) and those that required no further procedures over tests that required re-biopsy (β = 0.5523). Physician preferences were similar (β = 0.2758 and β = 0.857, respectively). Overall, there was a strong preference for genomic tests that have attribute profiles reflective of comprehensive genomic profiling (CGP) and whole exome sequencing (WES)/whole genome sequencing (WGS), irrespective of high costs. Participants preferred tests that provided actionable outcomes, were affordable, timely, and negated the need for additional biopsy.

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“…Considering the numerous established and emerging actionable biomarkers, sequential single-gene testing can potentially consume considerable tissue and time. Massive parallel sequencing, also known as next-generation sequencing (NGS), enables simultaneous sequencing of multiple biomarkers and represents a logical evolution to enable current and future precision oncology in NSCLC [10,[14][15][16][17]. NGS represents a more reliable and efficient approach to biomarker testing compared with sequential single-gene testing [14,16].…”

Section: Introductionmentioning

confidence: 99%

“…Massive parallel sequencing, also known as next-generation sequencing (NGS), enables simultaneous sequencing of multiple biomarkers and represents a logical evolution to enable current and future precision oncology in NSCLC [10,[14][15][16][17]. NGS represents a more reliable and efficient approach to biomarker testing compared with sequential single-gene testing [14,16]. In cases in which the tumour is inaccessible or the patient's performance status does not allow invasive tissue biopsy, liquid biopsy can provide valuable material for molecular diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Liquid Biopsy for Biomarker Testing in Non-Small Cell Lung Cancer: A European Perspective

Malapelle

Tiseo

Vivancos³

et al. 2021

JMP

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The development of targeted therapies has improved survival rates for patients with advanced non-small cell lung cancer (NSCLC). However, tissue biopsy is unfeasible or inadequate in many patients, limiting biomarker testing and access to targeted therapies. The increasing numbers of established and emerging biomarkers with available targeted treatments highlights the challenges associated with sequential single-gene testing and limited tissue availability. Multiplex next-generation sequencing (NGS) offers an attractive alternative and represents a logical next step, and in cases where the tumour is inaccessible, tissue biopsy yields insufficient tumour content, or when the patient’s performance status does not allow a tissue biopsy, liquid biopsy can provide valuable material for molecular diagnosis. Here, we explore the role of liquid biopsy (i.e., circulating cell-free DNA analysis) in Europe. Liquid biopsies could be used as a complementary approach to increase rates of molecular diagnosis, with the ultimate aim of improving patient access to appropriate targeted therapies. Expert opinion is also provided on potential future applications of liquid biopsy in NSCLC, including for cancer prevention, detection of early stage and minimum residual disease, monitoring of response to therapy, selection of patients for immunotherapy, and monitoring of tumour evolution to enable optimal adaptation/combination of drug therapies.

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Comparison of Sequential Testing and Next Generation Sequencing in advanced Lung Adenocarcinoma patients – A single centre experience

Cited by 25 publications

References 23 publications

Monitoring tumor growth rate to predict immune checkpoint inhibitors’ treatment outcome in advanced NSCLC

Monitoring tumor growth rate to predict immune checkpoint inhibitors’ treatment outcome in advanced NSCLC

Patient and Clinician Preferences for Genetic and Genomic Testing in Non-Small Cell Lung Cancer: A Discrete Choice Experiment

Liquid Biopsy for Biomarker Testing in Non-Small Cell Lung Cancer: A European Perspective

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