Major Advances in RET Inhibition for NSCLC and MTC - Episode 5

Best Practices for NGS Selection in NSCLC


Jared Weiss, MD: I want to address our attention to a much harder question that I know you don't want to answer, and I'm going to find uncomfortable too, but it will be of extraordinary utility to our community partners. When we do education events like this, we all talk about a broad and sensitive next-generation sequencing panel, or we may get a little more specific, and say one with a good RNA fusion panel, right? Our colleagues sitting at home are asking the question, “What should I order tomorrow with my white coat on; what is the best panel for my patients?”

Benjamin P. Levy, MD: Based on the platforms’ technology, I would say at Johns Hopkins Sidney Kimmel Cancer Center the safe answer for me is that we've moved to a DNA- and RNA-based platform, we do everything in house. But playing the role of somebody who doesn’t have that in-house capability, I’d recommend Caris Life Sciences and Tempus as 2 platforms that have a DNA- and RNA-based sequencing platform. FoundationOne also is moving that way, and you can order through FoundationOne a heme sarcoma panel. But on a routine basis, not that I have any dog in the fight here with these platforms, just looking at their technologies, if we're asking for a DNA- and an RNA-based platform, those are the 2 platforms that are the furthest along. I don't know what your thoughts are on that.

Jared Weiss, MD: We tend to use Tempus at my institution. I don't know a lot about the Caris platform, honestly, and I won’t address what I don't know well. Foundation’s heme panel is fine, but I've had some nonscience-based issues with it. More specifically, I've asked for it from community partners and had blood drawn. The word hemes has been sort of confused with plasma, and as well I’ve had at least 2 payers refused to pay it because the patient doesn't have lymphoma or leukemia. The name trips them up. Yes, I think scientifically it's a fine panel. I use Tempus just more for practical reasons than scientific ones, and I'm quite happy with that. I don't know much about the Caris platform.

Benjamin P. Levy, MD: They're both good. Again, I think our comments come on the line of just where the technology is and what technology suits the optimal interrogation for our patients.

Jared Weiss, MD: I did just want to arm our viewers with something that you can order commercially. I would also like to arm you to note that, just because the test says that it detects something doesn't mean that it actually does so very well. RET is one example of this. Another example that we have fresh data on is MET exon 14 deletion, where if you have a DNA-only panel, you're almost as likely to miss it as to catch it despite the DNA panel saying that they evaluate from that.

Benjamin P. Levy, MD: That's right, and good point. Practitioners out there need to know that RNA-based platforms are preferred for the detection of fusions, and there are commercially available assays that probably do this better than others.

Jared Weiss, MD: And payers pay for them, right? It's not an academic, pie in the sky, can't get it, crazy expensive thing. It's usable in everyday practice.

Transcript Edited for Clarity