The emerging clinical relevance of genomics in cancer medicine

Abstract

The combination of next-generation sequencing and advanced computational data analysis approaches has revolutionized our understanding of the genomic underpinnings of cancer development and progression. The coincident development of targeted small molecule and antibody-based therapies that target a cancer’s genomic dependencies has fuelled the transition of genomic assays into clinical use in patients with cancer. Beyond the identification of individual targetable alterations, genomic methods can gauge mutational load, which might predict a therapeutic response to immune-checkpoint inhibitors or identify cancer-specific proteins that inform the design of personalized anticancer vaccines. Emerging clinical applications of cancer genomics include monitoring treatment responses and characterizing mechanisms of resistance. The increasing relevance of genomics to clinical cancer care also highlights several considerable challenges, including the need to promote equal access to genomic testing.Developments in genomic sequencing technologies have enabled increasing amounts of information on the genomes of individual cancers to be revealed. At the same time, increasing numbers of therapies targeting specific genomic alterations are being made available, necessitating the use of genomics to diagnose and treat patients with cancer. In this Review, the authors describe the emerging clinical relevance of genomics in oncology, in addition to the many challenges that currently preclude routine clinical use.Key pointsGenomic assays that enable the characterization of the somatic and germline defects in individual tumour samples are increasingly being used in clinical diagnostics as a means of identifying therapeutic options.Many technical and cost-associated considerations have a role in decision-making processes regarding the implementation of cancer genomics assays into clinical practice.Genomic methods can reveal individual targetable alterations, mutational load, complex mutation signatures, and tumour-specific antigens, which might inform the utilization of targeted therapies, immune-checkpoint inhibitors, and personalized anticancer vaccines.The occurrence of shared targetable alterations across diverse tumour types has prompted new paradigms in the application of genomic profiling and the design of clinical trials.These assays increasingly provide information that is pertinent to clinical cancer care, although several important attendant challenges surround their implementation.