Dr Fox on the Timing of NGS Testing in NSCLC

“The question is: does everyone need NGS? It’s become the standard of care in [the US], especially in the metastatic stage, but in earlier stages, there’s a big question, because [NGS] does take time, it does cost money, and not all of those results may be needed before a surgical approach with or without systemic therapy is determined.”

Adam Fox, MD, an assistant professor in the Department of Medicine in the College of Medicine at the Medical University of South Carolina, discussed the process and timing of ordering next-generation sequencing (NGS) in patients with non–small cell lung cancer (NSCLC).

Fox began by noting that although NGS has largely become the standard of care in the United States for patients with NSCLC, especially those with metastatic disease, it remains unclear if every patient with early-stage disease needs to undergo testing. Fox noted that NGS takes time and costs money, and he highlighted that not all of the testing results may be required before a surgical approach, with or without systemic therapy, is selected. There are likely centers that are not performing NGS for patients with early-stage disease and favor more targeted testing approaches for these patients, he added.

The logistical processes for ordering NGS can differ between cancer centers, Fox explained, noting that he never hears the same answer twice when he asks colleagues from other centers about their processes for biomarker testing. A coordinated plan for ordering biomarker testing at the time of diagnosis is crucial, and the last individual who should be ordering the testing should be the medical oncologist at the time of the patient’s first visit, he added.

Ordering NGS at the time of a patient’s first visit to the medical oncologist likely means that time has been wasted between diagnosis and that visit, Fox argued. On average, it takes approximately 2 weeks from the time of biopsy to when biomarker testing is ordered, he noted.