Corey J. Langer, MD, director, Thoracic Oncology, Abramson Cancer Center, professor of medicine, Perelman School of Medicine, University of Pennsylvania, discusses the use of next-generation sequencing (NGS) in non–small cell lung cancer (NSCLC).
With a number of actionable mutations in NSCLC, it is critical to do NGS, Langer says. The biggest challenge with NGS is that the turnaround time is still 2 weeks, sometimes as long as a month. If a patient is particularly symptomatic, a physician might not be able to wait that long to start therapy, says Langer. In that case, chemotherapy and immunotherapy is typically administered, he adds.
On the other hand, physicians may be able to palliate symptoms using spot radiation to a bone lesion or brain lesion to buy time for the patient. NGS allows researchers to evaluate a large panel of genes with limited specimens, Langer notes. If NGS can be done feasibly, it should be, but if physicians suspect that a patient has an oncogenic driver, they should proceed with spot testing. For example, a never smoker of East Asian ethnicity with adenocarcinoma has a high likelihood of an EGFR or ALK mutation, Langer adds.