The uptake of next-generation sequencing (NGS) in clinical practice varies across the region.
A new report from the Asia-Pacific Oncology Drug Development Consortium (APODDC) working group provides guidance on the use of next-generation sequencing (NGS) for certain cancers in the region.
Notably, the report offers guidance from an Asian perspective, with experts supporting the use of routine NGS testing in patients with advanced non–small cell lung cancer (NSCLC). For this cohort, testing should be multigene and incorporated into daily practice, researchers suggested.
Findings were published in ESMO Open.
“Clinical adoption of NGS is heterogeneous in the [Asia-Pacific] region due to diversity in access, practice guidelines, and funding,” the authors explained. Socioeconomic status also impacts NGS uptake throughout the region.
Although the authors did recommend NGS use for patients presenting with NSCLC, they do not recommend routine multigene NGS testing for patients with metastatic gastric cancer, cholangiocarcinoma, nasopharyngeal cancer, breast cancer, or hepatocellular carcinoma.
Previous research has shown NGS can help predict survival benefits in individuals with certain cancers being treated with targeted drug therapies, the researchers added. However, no guidelines or recommendations from the Asian perspective exist when it comes to NGS use in individuals with metastatic cancer.
In 2020, more than 58% of all cancer deaths occurred in Asia. What’s more, “the burden, incidence, and mortality of cancer are rapidly increasing in Asia,” the authors wrote.
Breast cancer, cervical cancer, lung cancer, stomach cancer, CRC, and liver cancer are common among Asian women, and among Asian men, lung cancer, liver cancer, prostate cancer, and CRC frequently occur.
To construct the current report, the APODDC convened a group of experts in clinical cancer genomics. Specifically, the group assessed the applicability of NGS for 9 cancer types. The authors also carried out a literature review that included relevant articles published from January 2001 to November 2022.
Experts suggest “patients with epithelial OC [ovarian cancer] may be offered germline and/or somatic genetic testing for BReast CAncer gene 1 (BRCA1), BRCA2, and other OC susceptibility genes. Access to poly (ADP-ribose) polymerase inhibitors is required for NGS to be of clinical utility in prostate cancer.”
To identify alterations in colorectal cancer (CRC), the group recommends utilizing allele-specific PCR or small-panel multiplex-gene NGS.
NGS is a useful tool in that it can identify single-nucleotide mutations and large genomic rearrangements, the authors explained. Profiling with NGS can also help reduce diagnosis times compared with individual biomarker tests.
For patients with breast cancer, ovarian cancer, and nonsquamous NSCLC, clinical trials have revealed NGS-based diagnostics can improve patient survival outcomes.
NGS-based diagnostics for metastatic cancers is currently reimbursed in Japan, Australia, and South Korea, but is not reimbursed in Thailand, Hong Kong, Singapore, Malaysia, and the Philippines.
The group also found that apart from clinical trials, NGS testing in most of the included countries is self-funded, while “access to therapeutics that target genetic aberrations is limited to a restricted number of sites with drug development expertise,” the researchers wrote.
In addition, the low number of cost-benefit studies inhibit policymakers from determining the need for funding to support NGS in low- and middle-income countries.
Overall, the group stressed the importance of an end-to-end systems approach for precision oncology in the region.
“Greater availability and awareness of NGS testing in both clinicians and patients can ensure rapid adoption of these tests in clinical practice,” the authors wrote.
“There should be enhanced mechanisms for patients to access the latest cancer drugs that might be currently unavailable but approved by other regulatory agencies for specific indications,” they concluded.
Loong HH, Shimizu T, Prawira A, et al. Recommendations for the use of next-generation sequencing in patients with metastatic cancer in the Asia-Pacific region: a report from the APODDC working group. ESMO Open. Published online June 23, 2023. doi:10.1016/j.esmoop.2023.101586