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October 11, 2018

Plasma vs Tissue Next-Generation Sequencing in Non–Small Cell Lung Cancer—Either, Both, or Neither?

Author Affiliations
  • 1Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 2Swedish Cancer Institute, Seattle, Washington
JAMA Oncol. 2019;5(2):148-149. doi:10.1001/jamaoncol.2018.4304

Although randomized clinical trial evidence of superior outcomes from using next-generation sequencing (NGS) in oncology clinical practice is still lacking, NGS has earned a place in the routine management of non–small cell lung cancer (NSCLC) for practical reasons. Non–small cell lung cancer is distinctive in that the portfolio of biomarker-driven targets with matched drugs approved by the US Food and Drug Administration or at least potentially available drugs is increasing so rapidly that performing a panel test has become more efficient and probably more cost-effective than testing for each mutation individually.1 Furthermore, tissue samples are not always available, and additional procedures to retrieve needed tissue entail potential risk and discomfort. A solution to this dilemma has been to perform a “liquid biopsy,” in which the NGS is conducted on plasma rather than on tissue, obviating the need for invasive tissue biopsy. This more readily performed technique is already routinely used by many institutions, particularly when tissue biopsy specimens are unavailable. Like many other interventions in medicine, however, plasma-based NGS has been integrated into clinical practice without being evaluated in well-conducted prospective trials.

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