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Personalized medicine in colorectal cancer has lagged behind the breakthroughs experienced in other disease types, such as criztonib and erlotinib in lung cancer, suggest moderator John L. Marshall, MD. As the field continues to evolve, next-generation sequencing will likely play a larger role to identify patients for clinical trials, Fadi Braiteh, MD, CPI, believes.
In some cases, if a patient knows they have a specific mutation, they may ask to be treated with a targeted therapy that is approved for another indication, Axel Grothey, MD, states. In these situations, if the drug is administered, whether off-label or on a clinical trial, careful documentation is needed to demonstrate a difference in patient outcome.
Depending on the institution and test, a rebiopsy of the lesion may be required in order to gain an accurate genetic profile. In these situations, the cost-benefit ratios need to be considered to see if the additional costs associated with these procedures are warranted by potential improvements in outcome, says Tanios Bekaii-Saab, MD. At this point, these molecular tests primarily help to determine eligibility for clinical trials.
There are several questions that still need answered before the widespread use of next-generation sequencing is put into practice, states Alan P. Venook, MD. In general, it is unlikely that a single mutation is responsible for tumor growth in colorectal cancer. As a result, Venook suggests, future research will need to focus on targeted combinations against multiple alterations.