NGS for precision oncology in solid tumors: from research to clinical practice

Precision oncology is revolutionizing the diagnostic and therapeutic approach to cancer. In fact, the availability of tumor-specific and tumor-agnostic biomarkers and matched therapies is rapidly increasing. For example, targets for therapeutic intervention have been found in over 50% lung adenocarcinoma and intra-hepatic cholangiocarcinoma. Therefore, diagnostic laboratories will face the problem to assess different types of genetic alterations (single nucleotide variants, indels, copy number variation and gene fusions) in multiple genes in order to allow the identification of the most active treatment for patients with metastatic cancer. Next generation sequencing (NGS) and in particular targeted sequencing allows sequencing dozen to hundred genes in a single analysis. The European Society of Medical Oncology (ESMO) recently released recommendations on the use of NGS for patients with metastatic solid tumors. According to ESMO recommendations, NGS is the preferred diagnostic approach to assess actionable genomic alterations ready for clinical practice in selected cancer types, including lung adenocarcinoma, prostate cancer and cholangiocarcinoma. However, the use of larger panels for comprehensive genomic profiling is suggested in academic centers. These recommendations for the first time provide a rationale for the use of NGS in the clinical practice. The increasing number of biomarkers and matched therapies that are being approved will likely lead to an extension of the recommendation to use NGS to other tumor types.

Learning Objectives:
1. To increase the knowledge on precision oncology for solid tumors.
2. To increase the knowledge on the utility of next generation sequencing for genomic profiling of solid tumors.