Recommendations to improve the clinical adoption of NGS‐based cancer diagnostics in Singapore

Abstract

Next‐generation sequencing (NGS)‐based diagnostics have demonstrated clinical utility in predicting improved survival benefits with targeted treatment in certain cancer types, and positive cost–benefit in several healthcare systems. However, clinical adoption in Singapore remains low despite commercial availability of these diagnostics. This expert opinion review examines the key challenges to the clinical adoption of NGS‐based diagnostics in Singapore, provides recommendations on impactful initiatives to improve adoption, and also offers practical guidance on specific cancer types in which NGS‐based diagnostics are appropriate for use in Singapore. Limited patient affordability is one major challenge to clinical adoption of NGS‐based diagnostics, which could be improved by enabling patient access to more funds for specific cancer types with clear benefits. Expert opinion based on current evidence and clinical experience supports the upfront use of hotspot panels in advanced non–small cell lung cancer (NSCLC), metastatic colorectal cancer, advanced and recurrent ovarian cancer, and acute myeloid leukemia. Comprehensive genomic profiling could be considered for upfront use in select patients with NSCLC and ovarian cancer, or in refractory patients with the four cancer types. Wider adoption of NGS‐based diagnostics will improve the delivery of cancer care in Singapore and Asia‐Pacific, and thus lead to better patient outcomes.

Clinical Utility of Next-Generation Sequencing-Based Panel Testing under the Universal Health-Care System in Japan: A Retrospective Analysis at a Single University Hospital

“…NGS assay is widely considered a part of the routine care for patients with cancer, and it has been reimbursed in several Western and Asian countries [ 11 ]. In June 2019, two types of NGS-based panel testing, Foundation One CDX (F1CDx, developed by Foundation Medicine, Cambridge, MA) and OncoGuide NCC Oncopanel System test (developed by Japan’s National Cancer Center; NCC and Sysmex), were reimbursed by Japan’s universal health insurance system for patients with advanced cancer who finished standard treatment [ 12 , 13 , 14 ].…”

A case of tick-transmitted Q fever in Lishui, China diagnosed by next-generation sequencing

“…The important point is this platform is unbiased, and a variety of DNA sequences of bacteria, 20 viruses, 21 fungi, 22 and parasites 23 have been detected in clinical samples. In addition, NGS can also help guide the treatment of rare tumors 24 and genetic diseases. 25 …”

Molecular testing in stage I–III non-small cell lung cancer: Approaches and challenges

“…The choice of whether to analyze biomarkers using single gene testing or next generation sequencing (NGS) will vary between institutions based on a number of factors including cost, local reimbursement rules (which may impact on affordability where patients fund their own tests), approved treatments (dictating the need for specific molecular tests), the specific needs for an individual patient and required turnaround time, tissue quantity available, and local laboratory preference or capability. To date, most NGS testing is found in North America and European countries and is relatively uncommon in many Asian countries [58,59].…”