Virgilio Lorenzo Jr

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Photo courtesy of the Makati PIO, file

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<div><img src="https://od2-image-api.abs-cbn.com/prod/editorImage/1740270823909New Project (1).jpg" class="fr-fic fr-dib"/>Photo courtesy of the Makati PIO, file</div>In the last decade, Next-Generation Sequencing (NGS) has transformed cancer diagnosis and treatment worldwide, offering deeper insights into tumor biology, treatment resistance, and personalized therapy. This technology allows for rapid sequencing of DNA and RNA, paving the way for more precise, effective, and individualized cancer treatment strategies.However, in the Philippines, access to comprehensive genomic profiling (CGP), circulating tumor DNA (ctDNA), and cell-free DNA (cfDNA) analysis remains limited, often delaying optimal cancer management.As we push for world-class cancer care, integrating genomic profiling into standard practice is no longer a luxury but a necessity.<div>Understanding genomic testing: Comprehensive vs. Targeted Analysis</div>Cancer is a genetic disease, and molecular profiling is crucial in understanding its behavior. NGS-based testing can be categorized into:1) Comprehensive Genomic Profiling (CGP):• Analyzes hundreds of cancer-related genes simultaneously.• Detects single nucleotide variants (SNVs), insertions/deletions, copy number variations (CNVs), gene fusions, and microsatellite instability (MSI).• Ideal for hard-to-treat cancers, double primaries, and recurrent disease.2) Targeted or Focused Genetic Analysis:• Examines only a select number of genes known to drive specific cancers.• Used for single mutations like EGFR in lung cancer or BRCA1/2 in breast/ovarian cancers.• Limited in scope but useful for quick decision-making when a specific mutation is suspected.<div><a href="https://www.abs-cbn.com/news/health-science/2025/2/16/shining-a-light-on-biliary-cancers-the-challenge-of-cholangiocarcinoma-and-gallbladder-cancer-1219">Shining a Light on Biliary Cancers: The challenge of cholangiocarcinoma and gallbladder cancer</a></div><div>The role of ctDNA and cfDNA in precision oncology</div>1) Cell-Free DNA (cfDNA): Fragments of DNA released into the bloodstream by both normal and cancer cells.2) Circulating Tumor DNA (ctDNA): A subset of cfDNA derived specifically from cancer cells, carrying tumor-specific mutations.These liquid biopsy techniques have transformed oncology by providing real-time tumor profiling without the need for invasive biopsies.Their applications include:✔ Early Detection – Identifying molecular changes before a tumor is visible on imaging. ✔ Monitoring Treatment Response – Tracking tumor evolution in real-time and detecting resistance mutations. ✔ Minimal Residual Disease (MRD) Detection – Identifying microscopic cancer cells post- treatment to predict recurrence. ✔ Guiding Therapy Selection – Identifying actionable mutations for targeted therapy or immunotherapy. ✔ Surveillance – Early detection of metastasis or recurrence in high-risk patients.<div>Why these technologies must be accessible in the Philippines</div>Despite its clinical value, comprehensive genomic profiling and liquid biopsy remain out of reach for most Filipino cancer patients due to:   1) High cost and limited insurance coverage2) Lack of local laboratories offering high-throughput NGS 3) Limited awareness among healthcare providers4) Data accessibility and integration challengesGiven the high prevalence of hard-to-treat cancers like lung and ovarian cancers, hepatobiliary, pancreatic, and rare gastrointestinal malignancies, access to genomic technologies is critical in improving survival rates.<div>Using genomic data for risk assessment, diagnosis, and therapeutic impact</div>1. Risk Assessment• Identification of hereditary cancer syndromes (e.g., Lynch syndrome, BRCA mutations, APCfor colorectal cancer).• Early intervention and cancer screening programs for high-risk individuals.2. Precision Diagnosis• Differentiating primary vs. metastatic cancers for double primaries.• Classifying tumors based on molecular subtypes, ensuring correct treatment selection.3. Therapeutic Impact• Identifying targetable mutations for personalized therapy (e.g., FGFR inhibitors forcholangiocarcinoma, IDH1 inhibitors, immunotherapy biomarkers).• Predicting response to chemotherapy, avoiding unnecessary toxic treatments.4. Surveillance &amp; Recurrence Detection• ctDNA monitoring allows early detection of recurrence, often before it is visible on scans.• Liquid biopsies provide a non-invasive alternative to tissue biopsies in monitoring cancerprogression.<div>Building a genomic-ready cancer care system in the Philippines</div>To integrate genomic medicine into mainstream cancer care, we must:🔹 Expand local NGS and ctDNA testing facilities to lower costs and increase accessibility. 🔹 Advocate for PhilHealth and private insurance coverage for genomic testing in oncology. 🔹 Strengthen clinician education on the utility of CGP and liquid biopsy in decision-making. 🔹 Develop national cancer genomic databases for better data sharing and patient stratification. 🔹 Foster research collaborations to establish Filipino-specific genomic data for cancer risk profiling.<div>A call to action</div>Cancer care is rapidly evolving, and genomic medicine is the future. As Filipino cancer specialists, we must push for broader access to NGS and liquid biopsy technologies to bring global standard cancer care to our patients.The time to act is now. We must bridge the gap in precision oncology, empower Filipino patients with genomic-driven treatments, and improve survival outcomes across all cancer types.<div>--</div><div>Established in September 1936, the Philippine College of Surgeons is the country&#x27;s premier organization of surgical professionals. </div>

In the Philippines, access to comprehensive genomic profiling (CGP), circulating tumor DNA (ctDNA), and cell-free DNA (cfDNA) analysis remains limited, often delaying optimal cancer management.

In the Philippines, access to comprehensive genomic profiling (CGP), circulating tumor DNA (ctDNA), and cell-free DNA (cfDNA) analysis remains limited, often delaying optimal cancer management.

Unlocking the future of cancer care with Next-Generation Sequencing: Why the Philippines must keep up

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Unlocking the future of cancer care with Next-Generation Sequencing: Why the Philippines must keep up

ABS-CBN News,

Catherine SC Teh,

MD,

MSc,

FPCS,

FRCSEd,

(Hon)FACS,

G.CIEHF

Published Feb 23, 2025 08:34 AM PHT

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Next-Generation Sequencing

Cancer diagnosis

Cancer treatment

Philippine College of Surgeons

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