Many investigators believe that the future of mutation assays will be in multiplex testing, with which a critical issue is conserving what may be scant tumor tissue and extracting as much useful information as possible. At most tertiary centers, including those of Drs Wakelee and Ramalingam, all patients’ tissues are routinely assayed with a multiplex assay both for potential clinical trial referral and to guide nonprotocol care. However, this approach has not yet been adopted in the community, as more than half of oncologists have never ordered a multiplex panel and less than 20% appear to do so with any frequency.

Ma Z et al. Next-generation sequencing (NGS) in advanced lung cancer in the community: A molecular profiling program of the Sarah Cannon Research Institute (SCRI). Proc ASCO 2014;Abstract e19022.

Meldrum C et al. Next-generation sequencing for cancer diagnostics: A practical perspective. Clin Biochem Rev 2011;32(4):177-95. Abstract

Vignot S et al. Next-generation sequencing reveals high concordance of recurrent somatic alterations between primary tumor and metastases from patients with non-small-cell lung cancer. J Clin Oncol 2013;31(17):2167-72. Abstract