Next-Generation Sequencing Helps ‘Select the Best Treatment’ for Lung Cancer

For lung cancer, standard treatment regimens include surgery, radiation, chemotherapy, targeted therapies and immunotherapy. However, utilizing next-generation sequencing for lung cancer before treatment may provide patients with the personalized treatment regimen they need, an expert told CURE®.

According to the National Cancer Institute, next-generation sequencing (NGS) is a method researchers use to analyze the building blocks of DNA and RNA fragments simultaneously to determine any changes in the genome or specific genes. The purpose of next-generation sequencing is to identify the cause of certain diseases, including cancer.

“Next-generation sequencing is a piece of the puzzle needed to understand what treatments are best for patients with lung cancer. There are other ways to perform sequencing, so next-generation sequencing is almost a descriptive term. It's kind of like having, (4G) phone service and upgrading to (5G) phone service,” Dr. Adam Fox, assistant professor of medicine in the college of medicine at the Medical University of South Carolina in Charleston, explained to CURE®.

“(Next-generation sequencing is) a new laboratory method that allows us to assess genetic alterations or biomarkers in a patient's lung cancer. The next-generation portion of it really has to do with its capacity, its ability to take a small amount of tissue and rapidly, and in a large quantity, assess these biomarkers that help dictate whether one treatment or another treatment is best for an individual patient,” he added.

Biomarker testing (a method that samples tissue, blood and other bodily fluids to analyze certain genes, proteins and molecules for drivers of cancer) and NGS testing (a form of biomarker testing) are important for patients with lung cancer.

“When you talk about the importance of biomarker testing and NGS tests, then the importance comes down to the emerging benefits of precision medicine for cancer in general, and especially in lung cancer. Biomarkers and precision medicine treatments are a constantly evolving field,” Fox noted.

“In general, it seems as though precision medicine therapies offer patients better outcomes. And to deliver these precision therapies, you have to look to see if patients will respond to them,” he said. “And that's what these biomarker tests or NGS tests (do). They assess, ‘Is this patient going to respond to this medication?’”

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In terms of NGS’s current role in the treatment of lung cancer, Fox emphasized that it helps “select the best treatment” for patients.

“For most patients, (doctors) would like to have an assessment of these biomarkers for next-generation sequencing performed before (patients) receive any treatments to help guide the first and the best treatment,” Fox said. “In (most) cases, it helps triage people into what therapies to (receive). Again, at a metastatic stage, it dictates the first therapy.

“The therapy differences can be huge: if you are one of the smaller proportion of patients with a mutation found by NGS, you might only take a pill therapy for your cancer as the very first treatment for metastatic cancer. This is different from outcomes one may experience, especially when compared to chemotherapy.”

NGS’s future role in lung cancer treatment could potentially help welcome Food and Drug Administration (FDA) approvals for more targeted therapies, Fox said.

“For lung cancer treatment, it’s evolving every couple of years. So next-generation sequencing is this testing modality. It’s newer, it’s able to give us a lot of information in a relatively short amount of time,” Fox explained. “We expect over time that more targeted therapies specifically designed for what's driving people's cancers, to continue to expand. Each year since 2015, we've had one or two new biomarkers, which are detectable on next-generation sequencing, have new FDA-approved drugs.”

The role of NGS in the future for lung cancer can certainly benefit patients, especially regarding toxicities from treatments.

“For the future, we expect more. Tests need to be run on more genes because we'll hopefully continue to have more therapies to offer people,” said Fox. “Again, almost all of these targeted therapies are more desirable than chemotherapy, because they are often less toxic and more effective when biomarkers are matched with treatments. They each have their own side effects, (and those) are not all the same, but each in general has a safer side effect profile. In general, they each have better outcomes, including survival, and (fewer) side effects of the drug compared to chemotherapy.”

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