In which group of patients you would send for RNAseq for translocations/fusions that might be missed by NGS in advanced NSCLC?
Answer from: Medical Oncologist at Community Practice
In patients who are never/rare smokers in whom tissue NGS is negative, I would strongly consider RNAseq of a recent or fresh biopsy. You can find the occult fusion (or missed MET) in about 15% of NGS negative, TMB low cases based on this recent very nice paper from MSKCChttps://www.ncbi.nlm.nih.gov/...
Answer from: Medical Oncologist at Community Practice
I would add young age to that list of characteristics, say 50 or less. There are many NTRK fusions which I understand, due to the many fusion partners, may be missed by DNA seq alone and with and an ever-increasing number of new rare translocations reported, my first choice now would also be an RNA ...
Answer from: Medical Oncologist at Community Practice
Interestingly, emerging targets such as NRG1 fusions (with different partners) were detected by RNAseq in the MSK paper cited by @Sandip P. Patel. This novel/emerging target has been most commonly reported in Lung mucinous adenocarcinoma histology and has been targeted with afatinib in v...
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Medical Oncologist at Wexner Medical Center at The Ohio State University Institutionally, we have a "quick" panel that dete...
Medical Oncologist at Providence Hood River Memorial Hospital Our institutional panel (GeneTrails) does somethin...
Answer from: Medical Oncologist at Academic Institution
Frankly, my approach is to search until something is found. If a KRAS G12D is identified by DNA-based NGS, I am satisfied with the testing, but if no putative driver is identified at all, I strongly recommend RNA-based testing. Certain fusions, in particular, are prone to be missed by most DNA-based...