Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China.
Department of Pulmonary Medicine and Medical Oncology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan.
ESMO Open. 2023 Aug;8(4):101586. doi: 10.1016/j.esmoop.2023.101586. Epub 2023 Jun 23.
Next-generation sequencing (NGS) diagnostics have shown clinical utility in predicting survival benefits in patients with certain cancer types who are undergoing targeted drug therapies. Currently, there are no guidelines or recommendations for the use of NGS in patients with metastatic cancer from an Asian perspective. In this article, we present the Asia-Pacific Oncology Drug Development Consortium (APODDC) recommendations for the clinical use of NGS in metastatic cancers.
The APODDC set up a group of experts in the field of clinical cancer genomics to (i) understand the current NGS landscape for metastatic cancers in the Asia-Pacific (APAC) region; (ii) discuss key challenges in the adoption of NGS testing in clinical practice; and (iii) adapt/modify the European Society for Medical Oncology guidelines for local use. Nine cancer types [breast cancer (BC), gastric cancer (GC), nasopharyngeal cancer (NPC), ovarian cancer (OC), prostate cancer, lung cancer, and colorectal cancer (CRC) as well as cholangiocarcinoma and hepatocellular carcinoma (HCC)] were identified, and the applicability of NGS was evaluated in daily practice and/or clinical research. Asian ethnicity, accessibility of NGS testing, reimbursement, and socioeconomic and local practice characteristics were taken into consideration.
The APODDC recommends NGS testing in metastatic non-small-cell lung cancer (NSCLC). Routine NGS testing is not recommended in metastatic BC, GC, and NPC as well as cholangiocarcinoma and HCC. The group suggested that patients with epithelial OC 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. Allele-specific PCR or a small-panel multiplex-gene NGS was suggested to identify key alterations in CRC.
This document offers practical guidance on the clinical utility of NGS in specific cancer indications from an Asian perspective.
下一代测序（NGS）诊断已显示出在接受靶向药物治疗的某些癌症类型的患者中预测生存获益的临床实用性。目前，从亚洲的角度来看，尚无针对转移性癌症患者使用 NGS 的指南或建议。在本文中，我们提出了亚太肿瘤药物开发联盟（APODDC）关于转移性癌症中 NGS 临床应用的建议。
APODDC 召集了一组临床癌症基因组学领域的专家，（i）了解亚太地区（APAC）转移性癌症的当前 NGS 格局；（ii）讨论在临床实践中采用 NGS 检测的关键挑战；（iii）适用于当地使用的欧洲肿瘤内科学会指南进行调整/修改。确定了九种癌症类型[乳腺癌（BC）、胃癌（GC）、鼻咽癌（NPC）、卵巢癌（OC）、前列腺癌、肺癌和结直肠癌（CRC）以及胆管癌和肝细胞癌（HCC）]，并评估了 NGS 在日常实践和/或临床研究中的适用性。考虑了亚洲种族、NGS 检测的可及性、报销以及社会经济和当地实践特征。
APODDC 建议在转移性非小细胞肺癌（NSCLC）中进行 NGS 检测。不建议在转移性 BC、GC 和 NPC 以及胆管癌和 HCC 中常规进行 NGS 检测。该小组建议上皮性 OC 患者可进行胚系和/或体细胞遗传检测，以检测乳腺癌基因 1（BRCA1）、BRCA2 和其他 OC 易感性基因。为了使 NGS 在前列腺癌中具有临床实用性，需要获得聚（ADP-核糖）聚合酶抑制剂。建议使用等位基因特异性 PCR 或小面板多重基因 NGS 来鉴定 CRC 中的关键改变。
本文从亚洲的角度提供了关于 NGS 在特定癌症适应症中的临床实用性的实用指南。
