The diagnosis and treatment of lung cancer have evolved into the era of precision medicine. inhibitor crizotinib. Soda fusion gene in non-small cell lung malignancy (NSCLC) in 2007. In 2008, results from a phase I study suggested that advanced ALK-positive NSCLCs might be sensitive to crizotinib.3 A phase I expansion cohort involving 149 patients with advanced or (figure 1). Open in a separate window Figure 1 Survey on whether NGS MLN8054 manufacturer could replace the role of single gene detection in clinical practice.?NGS,?next-generation sequencing. Therefore, the expert panel agreed that for single, known, clinically actionable genetic alteration, ARMS is the recommended test for ctDNA detection; for multiparallel clinically actionable genetic alterations, NGS is the recommended test for ctDNA detection. Consensus 4: activating mutations and EGFR-tyrosine kinase inhibitors?(TKIs), the median overall survival (OS)?of advanced EGFR-positive NSCLC has been extended to approximately 36 months with EGFR-TKIs . Among patients with EGFR-negative lung cancer in China, several tens MLN8054 manufacturer of genetic abnormalities have been identified by NGS method. Despite a lack of consensus regarding whether these genetic alterations are targetable, MLN8054 manufacturer a point that deserves further evaluation, it is clear that NGS has demonstrated excellent performance in discovering novel genetic abnormalities. Dynamic monitoring of blood mutations in the FASTACT-2 study showed that status at cycle 3 might be a treatment-response predictor in patients with EGFR-positive NSCLC receiving first-line EGFR-TKI treatment. Patients who were mutation(-) at cycle 3 demonstrated significantly longer median PFS and OS as compared with those who were mutation(+) (median PFS: 12.0 months vs 7.2 months, p 0.0001; median OS: 31.9 months vs 18.2 months, p=0.0066).15 The use of NGS in monitoring resistance to targeted therapies has also been widely reported. Thress amplification, C1156Y mutation after MLN8054 manufacturer progression from first-line crizotinib treatment, which is sensitive to lorlatinib. As a result, lorlatinib was administrated, although the patient eventually relapsed. NGS genetic testing performed on the resistant biopsy identified a secondary L1198F mutation, in addition to C1156Y. L1198F probably offset the increased kinase activity due to C1156Y, leading to crizotinib resensitisation. The patient restarted crizotinib and had a clinically significant radiological response that lasted almost 6 months. A survey of at what circumstances TSPAN10 NGS-based genetic testing can be used indicated that 93% of experts favoured its use in patients who develop acquired resistance to targeted agents, and 80% of experts preferred to use it inpatients failing to respond to current treatments, without available effective therapies(figure 2). Open in a separate window Figure 2 Survey on when NGS-based genetic testing can be used in clinical practice.?NGS,?next-generation sequencing. Therefore, the expert panel recommended that NGS-based ctDNA detection could be used to discover novel molecular alterations, to monitor prognosis and response, and to determine resistance systems to targeted real estate agents. However, it should be cautioned these potential applications of NGS need further intensive validation. The above-mentioned outcomes from case reviews and stage I medical studies with little cohort sizes can’t be straight translated into medical practice. Consensus 5: entitled Water cancer biopsy: The continuing future of tumor recognition? elevated many issues and concerns concerning both technical and ethical aspects.22 Technical problems including increased recognition sensitivity can result in an increased threat of false positives, no common biomarker for many cancer types continues to be identified. Ethical queries, such as dealing MLN8054 manufacturer with the potential risks of overtreatment as well as the trade-offs between early detection and psychological distress, have also been proposed. Along with the opportunities offered by new techniques come novel challenges. NGS faces challenges in China, despite its rapid growth. At the summit meeting, 87% of experts suggested that the main obstacles hindering NGS from large-scale clinical implementation are high cost, lack of market standardisation and guarantees of test quality. As cost-efficiency is a key factor in clinical practice, the expert panel agreed that when applying NGS-based liquid biopsy in clinical practice, a.