Tumor-agnostic precision oncology: striving to prioritize internationalization for the management of cancer patients

Excerpt

The last 3 years have seen a paradigm shift in the regulatory approval of cancer treatments. With the approval of the first three agents, pembrolizumab and larotrectinib/entrectinib, for the treatment of solid tumors based on the presence of specific biomarkers rather than on tumor site, the precedent of tumor-agnostic precision oncology has been established. However, these approvals pose several clinical questions regarding the optimal use of tumor-agnostic agents. Uncertainties include the appropriate patient selection, timing, and methodology of microsatellite instability (MSI)/deficient mismatch repair (dMMR)/neurotrophic tyrosine receptor kinase (NTRK) testing, and also the sequence of administration of these agents in the treatment context of patients with MSI/dMMR or NTRK fusion-positive solid tumors. In consideration of the knowledge that the prevalence of MSI/dMMR is low in most common solid tumors and the prevalence of NTRK fusions is extremely low, it is critical that clinicians understand whether all cancer patients should be tested, and if so, when, and using which test(s). …