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This article is part of a series of case studies on the use of NGS and digital tools to drive precision oncology in the Asia Pacific region. Scroll to the bottom of the article for the full list.
With over a million new cancer cases diagnosed annually in India, this country has a serious need for better diagnostics to facilitate prevention, diagnosis and treatment of the disease. Next-generation sequencing (NGS) will likely play a growing role, according to Dr Amit Rauthan, Consultant Medical Oncologist at Manipal Hospital in Bengaluru, India. In this Q&A, he shares insights on the challenges and opportunities for greater NGS adoption in the country.
NGS usage in India today
For lung carcinomas that are treated in Dr Rauthan’s institution, NGS is used frequently and early at the first-line in certain cancers because its reports are valuable for decision making. A medical oncologist typically drives the use of NGS, and many will also integrate it into certain second and third-line situations to get answers.
“Lung is one place where they really push for getting NGS as early as possible,” he says. “We make decisions by it quite frequently.”
For some lung cancers, such as EGFR and ALK mutations, NGS can be repeated to assess resistance and determine if changes in therapy are needed. It is generally not performed for response monitoring or to detect clonal or progressing disease as this is very expensive and the utility of this is not known. Apart from lung cancer and later lines in breast or colon cancers, NGS is not used upfront as the information it yields is unlikely to change decisions on second-line therapy at this point in time.
Many clinicians want to learn more about NGS screening, but there is still an information gap in how NGS data is used for patients and the survival benefits. Global evidence in support of NGS may be sufficient for adaptation to the India context, but more local evidence is needed to help expand NGS coverage and utility, and also allow local patients and doctors to better relate to it.
Clinician education about NGS will be important, and Dr Rauthan feels that education providers need to understand the needs and motivations of their learners. Some may want to understand the science behind NGS, the biochemistry and mechanics of tests, the depth of coverage and how to make clinically-meaningful data interpretations. Others who are short on time may seek advice on practical implementation or personal narratives of NGS successes.
Dr Rauthan notes that Manipal Hospital is actively working to improve clinician awareness and adoption of NGS tools. Patients are also starting to understand NGS and its benefits, but general awareness among patients is minimal and cost remains a barrier to patient access in India.
The benefits (and limits) of digital tools for MTBs
For NGS report interpretation, Dr Rauthan considers molecular tumour boards (MTBs) to be very important for patient care. He notes that a “mini-MTB” with just ten minutes of discussion between scientists and clinicians can yield useful, targeted interpretations, especially for questions about the impacts of a mutation.
“MTBs are very useful and can unearth the knowledge needed to understand NGS reports, allow questions to be asked, and make information accessible,” he says. “But it doesn’t need to be a detailed MTB and it can be a very quick one for each report.”
Dr Rauthan acknowledges that the success of MTBs depends on all clinicians being able to assemble and share data. He notes that Manipal Hospital has digital tools and platforms to record and share information, which helps to facilitate multidisciplinary discussions across departments to ensure the continuity of cancer care.
In addition to digital tools that improve MTB workflows and collaboration, Manipal Hospital was also an early adopter of artificial intelligence applications for clinical decision support. While the hospital continues to invest in novel information technologies, however, Dr Rauthan thinks that it will be some time before these technologies provide meaningful assistance in data interpretation.
Another challenge is the issue of sharing patient information. It is currently difficult to transmit such data beyond hospital systems into sources accessible by other clinicians or scientists. Technology must be developed to improve information access, retrieval and sharing, within and across healthcare centres.
With recent data showing that novel mutations are being detected more frequently, doctors and scientists must aim to overcome these challenges in order to delve into the country’s genomic data and devise the best possible measures for disease prevention, diagnosis and treatment.
To learn more about the evolving role of next-generation sequencing, molecular tumour boards and clinical decision support tools in cancer care, check out some of these other case studies:
