Clinicians Should Look Beyond NGS When Delivering Precision Oncology: Joshua K. Sabari, MD

Joshua K. Sabari, MD, director of High Reliability Organization Initiatives at NYU Langone Health's Perlmutter Cancer Center, spoke about his participation in the recent Institute for Value-Based Medicine® (IVBM) event, highlighting the topics of discussion that night, which included how to get patients the best targeted therapies and the use of next-generation sequencing (NGS).

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

What did your IVBM panel, “Delivering the Promise of Precision Oncology,” focus on?

We had an exciting discussion at “Driving the Future of Cancer Care” at the Institute for Value-Based Medicine in New York City. We discussed delivering the promise of precision oncology. We discussed about building teams across centers including pathology, medical oncology, thoracic surgery, general surgery, [and] surgical oncology, to think about how we could better utilize tissue—acquisition of tissue, but more importantly, testing of tissue. We know that there is a revolution occurring in solid tumor oncology right now, where understanding the underpinnings of the cancer, the molecular alterations, is helping drive clinical care. And not only are they helping drive clinical care, but they're improving outcomes for patients. We really talked about how to deliver this care for patients across large systems, so thinking about who orders the testing. Who orders it? How is it ordered? Who follows up on the test, and who's making then the selection for these therapeutic options? And I was quite impressed. Doctors from Northwell, from NYU [New York University], from Yale, really across the spectrum, had great ideas on thinking about reflex testing of next-generation sequencing in order to not miss any patient and to give every single patient the best possible opportunity for potential match targeted therapy to improve their outcomes and their quality of life.

What is the importance of considering all testing methods, including NGS, to personalize care for patients?

Precision medicine really is a buzzword in 2025 and beyond. It really means looking at each individual patient in a unique way to provide the best possible therapy for them. Take lung cancer, for example: no 2 lung cancers are the same. They have different driver mutations, different PD-L1 expression, as well as other markers that may help guide therapy. I think the basis, or the baseline, is obtaining broad panel next-generation sequencing. But I think we need to move beyond that, thinking about the future of novel therapy development, other immunohistochemical assays, proteomic assays we had discussed. Really thinking about the patient in a totality, as a whole: What are different therapeutic options that may be available?

Again, IVBM really focuses on how we can build systems and teams across large centers to deliver precision care to the individual patient at the bedside. Great things are happening across many systems now, thinking about how to sort of universalize the opportunity for not just broad panel next-generation sequencing on tissue, but also on plasma, blood-based testing. We're doing that as standard of care now on all patients with stage IV disease. There are also real opportunities to monitor blood-based assays as well. We also talked a lot about cost and thinking about how to rein these in and to make sure that we're bringing value to patients at the bedside, matching them to potential targeted therapies, and again, allowing patients to have good quality of life in their journey with cancer.