The application of precision medicine in clinical practice implies a thorough evaluation of actionable genomic alterations to streamline therapeutic decision making. Comprehensive genomic profiling of tumor via next-generation sequencing (NGS) represents a great opportunity but also several challenges. During the 2023 San Raffaele Retreat, we aimed to provide expert recommendations for the optimal use of NGS in urothelial carcinoma (UC).
A modified Delphi method was utilized, involving a panel of 12 experts in UC from European and United States centers, including oncologists, urologists, pathologists, and translational scientists. An initial survey, conducted before the meeting, delivered 15 statements to the panel. A consensus was defined when ≥70% agreement was reached for each statement. Statements not meeting the consensus threshold were discussed during the meeting.
Nine of the 15 statements covering patient selection, cancer characteristics, and type of NGS assay, achieved a consensus during the survey. The remaining six statements addressing the optimal timing of NGS use, the ideal source of tumor biospecimen for NGS testing, and the subsequent need to evaluate the germline nature of certain genomic findings were discussed during the meeting, leading to unanimous agreement at the end of the conference.
This consensus-building effort addressed multiple unanswered questions regarding the use of NGS in UC. The opinion of experts was in favor of broader use of NGS. In a setting where recommendations/guidelines may be limited, these insights may aid clinicians to provide informed counselling and raise the bar of precision and personalized therapy.
Clinical genitourinary cancer. 2024 Apr 10 [Epub ahead of print]
Valentina Tateo, Antonio Cigliola, Chiara Mercinelli, Neeraj Agarwal, Petros Grivas, Ashish M Kamat, Ewan A Gibb, Marco Moschini, Maurizio Brausi, Lars Dyrskjøt, Yohann Loriot, Shilpa Gupta, Maurizio Colecchia, Philippe E Spiess, Jeffrey S Ross, Andrea Necchi
Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy. Electronic address: ., Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy., Huntsman Cancer Institute (NCI-CCC), University of Utah, Salt Lake City, UT., Division of Hematology Oncology, Department of Medicine, University of Washington, Seattle, WA., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX., Veracyte, Inc, San Francisco, CA., Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy., Department of Urology, Cure Hesperia Hospital, Modena, Italy., Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Département de Médecine Oncologique, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France., Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH., Department of Pathology, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Department of GU Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL., Foundation Medicine, Inc., Cambridge, MA; SUNY Upstate Medical University, Syracuse, NY., Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.