Next-Generation Sequencing in Lung Cancer Found to Be Accurate and Cost-Effective

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The leading cause of all cancer deaths is lung cancer. Most lung cancer cases are non–small-cell lung cancer (NSCLC), which accounts for 85% of all cases. NSCLC has a poor prognosis with an overall 5-year survival rate of 24%. For those patients diagnosed with advanced or metastatic NSCLC, the survival rate drops to 6%. NSCLC is often associated with targetable mutations, which allow for expanded treatment options for patients. Current treatment guidelines recommend tyrosine kinase inhibitor therapy for patients with actionable driver mutations. As an example, tumors with EGFR, BRAF, and RAS mutations; ALK, NTRK, RET, or ROS1 fusions; and MET tyrosine kinase abnormalities are treated with tyrosine kinase inhibitors, making genetic testing an important step in treatment management. Tissue biopsy is valuable to help determine genetic markers, but it is invasive and only a limited number of tests can be performed on a given sample. To maximize testing, next-generation sequencing (NGS) and liquid biopsy are viable testing alternatives. However, NGS can be costly and currently liquid biopsy does not have an established diagnostic value.

To assess the diagnostic accuracy and the economic value of these 3 different sampling tests, a literature review was conducted to compare NGS versus single-gene testing and liquid biopsy versus tissue biopsy. The results were published in Future Oncology. Publications included in the review were those studies that included ≥100 adult patients with advanced, recurrent, and/or metastatic NSCLC and were related to NGS and liquid biopsy. Conference abstracts were also included in this review.

From 375 screened full-text studies, 42 studies were found to be relevant. NGS versus standard molecular testing was described in 14 studies, and 28 studies evaluated liquid biopsy versus tissue biopsy. The studies that reported diagnostic outcomes from NGS versus standard testing were all observational. There were 10 studies on the economics of NGS versus standard testing; 6 of these studies assessed cost-effectiveness. The majority of the 25 studies comparing liquid biopsy versus tissue biopsy were observational studies. There were 3 studies that compared economic outcomes. Most of the studies were conducted in North America, with studies from Europe and Asia also included in the final review.

NGS was as accurate as testing a single gene, but it takes more time to perform. NGS can also yield more information, potentially reducing overall costs and leading to more patients receiving targeted therapy. Liquid biopsy took less time to obtain results and reduced costs over tissue biopsy, but it was not found to be as accurate as tissue biopsy, although it may be a viable initial screening tool.


Zheng Y, Vioix H, Liu FX, et al. Diagnostic and economic value of biomarker testing for targetable mutations in non-small-cell lung cancer: a literature review. Future Oncol. 2022;18:505-518.

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