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Somatic Genomic Testing for Metastatic or Advanced Cancer

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3 Table 1. Select Definitions of Commonly Used Terms in Precision Oncology Term Definition Biomarker A biological marker that can be detected and measured by a validated test to diagnose or treat disease, including genes, genomic alterations, ribonucleic acid (RNA) transcripts, proteins, post-translationally modified forms of proteins, and signatures of combinations of the aforementioned biomarkers. Circulating tumor DNA (ctDNA) Tumor deoxyribonucleic acid (DNA) shed into the plasma. Clonal Tumor cells derived from the division of a common ancestral tumor cell. Copy number variation (CNV) Deviation from the expected two copies of a gene within a cell. • Amplification: An increase in the number of gene copies within a cell beyond the expected two copies. Amplifications may be focal and limited to a specific gene or part of a broader, typically lower level, chromosomal gain. • Deletion: A decrease in the number of copies of a gene due to the loss of a single copy (heterozygous deletion) or both copies (homozygous deletion). Fusion A novel gene product that is created from two previously separate and independent genes. Genomic alteration Alteration of a gene from its original wildtype (normal) status through mutation, CNV, or rearrangement. Genomic instability A high frequency of mutations within the tumor's genome, which may be caused by loss of expression or function of proteins that direct DNA repair and/or are involved in mitotic checkpoints. Genomic instability score (GIS) A measurement of genomic instability that reflects homologous recombination deficiency. The companion diagnostic for niraparib utilizes a GIS, which measures the presence of telomeric allelic imbalance (TAI), loss of heterozygosity (LOH), and large-scale state transitions (LST) i.e., large structural variants. Genomic biomarker-linked therapy Therapy selected to target specific genomic alterations detected within the tumor. This includes targeted therapy designed to inhibit gain-of-function mutations in oncogenes, loss-of- function mutations in tumor suppressors, or other pathways sensitive to specific therapies due to the presence of a genomic alteration. Germline Mutations (variants) that are present within the egg and sperm that united to form the zygote from which an individual develops and are thus heritable. Inherited germline mutations are present within both tumor and normal samples sequenced.

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