Tan David Shao-Peng, Tan Daniel Shao-Weng, Tan Iain Bee Huat, Yan Benedict, Choo Su Pin, Chng Wee Joo, Hwang William Ying Khee
Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Health System, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Asia Pac J Clin Oncol. 2020 Aug;16(4):222-231. doi: 10.1111/ajco.13339. Epub 2020 Apr 16.
Next-generation sequencing (NGS)-based diagnostics have demonstrated clinical utility in predicting improved survival benefits with targeted treatment in certain cancer types, and positive cost-benefit in several healthcare systems. However, clinical adoption in Singapore remains low despite commercial availability of these diagnostics. This expert opinion review examines the key challenges to the clinical adoption of NGS-based diagnostics in Singapore, provides recommendations on impactful initiatives to improve adoption, and also offers practical guidance on specific cancer types in which NGS-based diagnostics are appropriate for use in Singapore. Limited patient affordability is one major challenge to clinical adoption of NGS-based diagnostics, which could be improved by enabling patient access to more funds for specific cancer types with clear benefits. Expert opinion based on current evidence and clinical experience supports the upfront use of hotspot panels in advanced non-small cell lung cancer (NSCLC), metastatic colorectal cancer, advanced and recurrent ovarian cancer, and acute myeloid leukemia. Comprehensive genomic profiling could be considered for upfront use in select patients with NSCLC and ovarian cancer, or in refractory patients with the four cancer types. Wider adoption of NGS-based diagnostics will improve the delivery of cancer care in Singapore and Asia-Pacific, and thus lead to better patient outcomes.
基于新一代测序（NGS）的诊断方法已在某些癌症类型中显示出临床效用，即通过靶向治疗可提高生存获益，并且在多个医疗系统中具有积极的成本效益。然而，尽管这些诊断方法在新加坡已有商业供应，但临床应用率仍然很低。本专家意见综述探讨了新加坡基于NGS的诊断方法临床应用面临的关键挑战，提出了关于提高应用率的有效举措的建议，并为新加坡适合使用基于NGS的诊断方法的特定癌症类型提供了实用指南。患者可承受性有限是基于NGS的诊断方法临床应用的一大挑战，通过让患者能够获得更多资金用于具有明确获益的特定癌症类型，这一情况可能会得到改善。基于当前证据和临床经验的专家意见支持在晚期非小细胞肺癌（NSCLC）、转移性结直肠癌、晚期复发性卵巢癌和急性髓细胞白血病中 upfront 使用热点 panel。对于部分NSCLC和卵巢癌患者，或这四种癌症类型的难治性患者，可考虑 upfront 使用全面基因组分析。更广泛地采用基于NGS的诊断方法将改善新加坡和亚太地区癌症治疗的提供情况，从而带来更好的患者预后。
