Multiplex Testing a Practical Requirement
Hello. I am Mark Kris from Memorial Sloan-Kettering Cancer center in New York. Today I want to discuss the recent release of the National Comprehensive Cancer Network (NCCN) guidelines [available at: http://www.nccn.org/professionals
/physician_gls/recently_updated.asp] for non-small cell lung cancer (NSCLC). The guidelines document goes over all of the changes that have been made, and there are quite a few. I want to highlight a couple of those changes.
The first, on page NSCL16, concerns the treatment of patients with recurrent or metastatic disease. Years ago, the guidelines began to recommend upfront testing for EGFR mutations and ALK rearrangements in patients with adenocarcinoma and for patients with squamous cell cancer who had tiny biopsy specimens or were never smokers. Those recommendations are intact and read the same way, but this statement has been added: "Testing for these 2 targets should be conducted as part of a multiplex/next-generation sequencing program." This is a very important change; first and foremost it reflects a current reality that it is actually simpler and ultimately more robust to test for all of the relevant oncogenic drivers for patients with lung cancers. To me, the best analogy is the CBC. If you need only a platelet count, frankly, I do not think it is possible to order it in isolation nowadays. You automatically receive a white blood cell count, a hemoglobin level, and other red blood cell indices. Mutational testing for known oncogenic drivers is similar.
This is important for several reasons. First is the economy of tissue; doing several tests, one after the other, is a huge demand on the amount of often limited tissue and, more important, on time resources. Moreover, if the first test ordered happens to show the change in the patient's tumor, that is wonderful, but what if it is the sixth test? By then it may be too late for that patient, and the time may have passed for implementation of a very effective therapy.