Challenges to NGS Testing for Follicular Lymphoma in the Community Setting

EP: 1.The Clinical Utility of Updated Immunophenotyping Guidelines in Follicular Lymphoma

Now Viewing

EP: 2.Challenges to NGS Testing for Follicular Lymphoma in the Community Setting

There are disparities in the practical implementation of modern diagnostic tools, particularly NGS, between highly specialized academic centers and community oncology practices. While NGS panels are now routinely utilized in academic settings, their accessibility and implementation remain significantly limited within the community.

This is likely in part because specialists in the academic setting deal exclusively with diseases like lymphoma, enabling a constant, deep focus on evolving molecular data. In contrast, community oncologists must manage a far wider array of common malignancies, such as breast, lung, and colon cancers, where molecular testing is often an essential component of the standard of care.

Importantly, NGS is not yet considered essential for the management of follicular lymphoma, and patients can often do well on treatment without it, which may also contribute to the slower adoption rate in less specialized environments.

In terms of how these diagnostic advancements influence treatment decisions, defining the optimal treatment sequencing remains a complex issue. However, molecular analysis provides a definitive impact on the selection of one specific therapeutic agent: the EZH2 inhibitor tazemetostat.

The presence or absence of an EZH2 mutation is the single most actionable finding. When the EZH2 mutation is detected, the known higher response rate to tazemetostat prompts clinicians to utilize the drug earlier in the patient’s treatment course. Conversely, if the mutation is absent, tazemetostat is typically reserved and administered later within the treatment algorithm, illustrating a direct and immediate influence on personalized therapy dictated by molecular findings.