Dr Shouse on the Importance of NGS Testing in Follicular Lymphoma

Geoffrey Shouse, DO, PhD, assistant professor, Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, discusses the importance of testing for genetic abnormalities through next-generation sequencing (NGS) in patients with follicular lymphoma (FL).

NGS plays a crucial role in identifying genetic abnormalities in FL, though its full potential is still being realized, Shouse begins. The field of NGS is rapidly advancing and will likely prove useful at various levels as researchers continue to explore its applications, according to Shouse. One promising use of NGS is identifying therapeutic targets in patients whose disease has relapsed multiple times, particularly when standard treatments are no longer effective, he explains. NGS can also detect high-risk mutations, such as TP53, which are known to confer resistance to chemotherapy, making it crucial to tailor treatment strategies for these patients accordingly, Shouse reports.

In current practice, NGS is particularly valuable for selecting patients who may benefit from targeted therapies, Shouse continues. For example, in FL, EZH2 mutations are routinely screened for when considering treatment with tazemetostat (Tazverik), as these mutations are associated with a higher likelihood of response, Shouse states. Although resistance mechanisms like BTK mutations have been observed in other cancers, such as chronic lymphocytic leukemia, their role in FL remains unclear, he reiterates. As the use of BTK inhibitors increases in the FL setting, it will be important to investigate these resistance mechanisms further, Shouse emphasizes.

Looking ahead, the potential for targeted therapies in FL is significant, especially when considering combination treatments, Shouse expands. Because targeted therapies are generally well tolerated, they can be combined with other treatments without introducing excessive toxicity, Shouse explains. By targeting multiple pathways from the outset, there is potential for achieving deeper and more durable remissions, leading to prolonged disease control, he says. Although combination therapies are still in the early stages of testing in FL, their future potential is substantial and has yet to be fully explored, Shouse concludes.