|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 157-158
Authors' reply to Batra et al., Chadha et al., and Deb et al.
Akhil Kapoor1, Vanita Noronha1, Anuradha Chougule1, Vijay M Patil1, Nandini Menon1, Amit Joshi1, Pratik Chandrani1, Rajiv Kumar2, Vikas Talreja1, Hollis D'Souza1, Kumar Prabhash1
1 Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
2 Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
|Date of Submission||02-Jan-2020|
|Date of Acceptance||01-Feb-2020|
|Date of Web Publication||24-Feb-2020|
Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kapoor A, Noronha V, Chougule A, Patil VM, Menon N, Joshi A, Chandrani P, Kumar R, Talreja V, D'Souza H, Prabhash K. Authors' reply to Batra et al., Chadha et al., and Deb et al. Cancer Res Stat Treat 2020;3:157-8
|How to cite this URL:|
Kapoor A, Noronha V, Chougule A, Patil VM, Menon N, Joshi A, Chandrani P, Kumar R, Talreja V, D'Souza H, Prabhash K. Authors' reply to Batra et al., Chadha et al., and Deb et al. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Apr 8];3:157-8. Available from: http://www.crstonline.com/text.asp?2020/3/1/157/279118
We thank Batra et al. for reading our article and for their comments on the utility of next-generation sequencing (NGS) and of a molecular tumor board (MTB) in the management of advanced non-small cell lung cancer (NSCLC). The availability of NGS has necessitated the consideration of genomic sequencing in the clinical decision-making in the era of personalized medicine. In addition, the discussion of patients in MTB becomes important as a lot of expertise is needed in the interpretation of reports, especially when multiple targets have been identified in the NGS report.
The comments of Chadha et al. provide important insight into the subject. The lung cancer molecular signature is highly complex and heterogeneous. To solve such a great puzzle, NGS-based concurrent detection of actionable variants and fusions should replace the sequential testing. Comprehensive NGS can minimize tissue wastage and turnaround time for patients. The cumulative time-to-test results and initiating treatment in the model generated by Pennell et al. was 2 weeks for upfront NGS and hotspot panel testing compared with 4.8 weeks for sequential testing with or without KRAS testing. Thus, upfront comprehensive testing was at least 2.8 weeks faster than the conventional sequential approach. Furthermore, upfront NGS testing resulted in large cost savings, surpassing $1.5 million as against sequential individual-gene testing for a theoretical population of 2066 Medicare-insured patients based on reimbursement rates of the Centers for Medicare and Medicaid Services.
The authors would like to thank Deb and Kumar for their critical evaluation of the manuscript and their comments. As the patient is still on first-line afatinib, schematic presentation of treatment protocol would not have added much value. The immunohistochemistry (IHC) for programmed death-ligand 1 (PD-L1) is a routine procedure at our institute and therefore, we did not add the figure of the PD-L1 IHC result. The authors have made an important point about androgen receptor (AR) positivity in NSCLC. In a study presented at the American Association for Cancer Research Annual Meeting 2017, IHC staining of AR revealed that 10 out of 88 patients with NSCLC (11%) had AR-positive staining in their tumor which included six adenocarcinomas and two squamous cell carcinomas. However, it should be noted that AR expression has been reported to negate the association of a high Ki67 and poor outcome. Basically, AR expression can modify the effect of high Ki67 on outcome. When both are expressed, no association with recurrence or survival has been reported (hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.31–4.36 for AR− Ki67+ versus HR, 1.54; 95% CI, 0.44–5.37 for AR+ Ki67+). However, the predictive value of AR expression in terms of response to AR blockers is currently unknown.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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