Next-generation sequencing has enabled unprecedented advances in oncology: personalized therapies are becoming possible, pathologists have gained unparalleled insights into the nature of tumors, and artificial intelligence can arrive at reliable diagnosis based on the immense data created by sequencing. Prof. Paul Hofman, a pathologist at the University of Côte d’Azur, France, wonders if doctors like him will even be needed in the future. We visited him at Nice Hospital.
Do all these new approaches mean that the era of glass slides and microscopes in pathology is over, Prof. Hofman?
PROF. PAUL HOFMAN: No, the key is integration. There is not just one single tool in the future of cancer therapy. We need everything. Liquid biopsy, histology, bio-pathology, sequencing, clinical data, behavior, microbiome, etc., and yes, old-fashioned tissue samples under the microscope.
What challenges do you face in your everyday work?
On the one hand, the multitude of methods gives us completely new possibilities, but they are also limited by one factor: the amount of sample material. Sometimes we have only a few hundred tumor cells for evaluation, so we cannot do one test after the other, because there simply is not enough material. Molecular biological technologies such as NGS are the only proven means to obtain answers from such small amounts of starting material.
What about communication with the attending physicians – are you in direct contact with them?
You speak to another gap. The link between pathology and diagnosis must be made narrower. Pathology is the hotspot for everything, and I do not say that because I am a pathologist myself. But we need, for example, the clinical data to help guide our choice of analytical method, because the suitability of a method of analysis also depends on whether the patient is a young nonsmoker or a retiree of 70 who has smoked for many years.
Why did you choose the GeneReader?
Without NGS, a modern laboratory is unimaginable today. There were calls for a better traceability of the workflow, which the GeneReader provides. We also save a lot of time with the device: processes that used to take 45 minutes are now completed in five to ten minutes. The good reports generated by the system which provide actionable insights are another reason. The operation is simple; the results are very robust. I like the restrictive panel as this ensures the most relevant results from the low DNA concentration in the samples. It really is a very powerful NGS system.
What is the future of these systems?
In the future the interaction with liquid biopsy will be interesting. We will be able to discover a lot by NGS in blood samples. It will become even more interesting if we use NGS with combinations of blood and tissue. That is another advantage of the GeneReader – we can analyze both with the same workflows.
What question are you currently most concerned with in your research?
It is about the constitutional genetics – the question of why some people smoke their whole lives but do not develop cancer while others do, although they never touched a cigarette.