Identifying Gene Fusions Gives Genomic Testing a Greater Role in Sarcoma

At the 4th Annual Miami Cancer Institute Precision Oncology Symposium on January 30 to 31, 2026, Neeta Somaiah, MD, professor and department chair in the department of sarcoma medical oncology in the division of cancer medicine at The University of Texas MD Anderson Cancer Center in Houston, Texas, observed that the landscape of sarcoma treatment is rapidly evolving, with genomic testing moving beyond specialized academic centers and into broader community practice. Although its application remains somewhat limited in localized disease, she emphasizes that genomic testing has established a definitive and expanding role in the management of advanced-stage sarcomas.

A primary utility of genomic testing in this field is the refinement of subtyping. Because sarcomas are frequently driven by fusions, where 2 genes combine to form a specific fusion protein that triggers oncogenesis, comprehensive testing is valuable. Somaiah notes that modern genomic panels that include fusion testing are critical for identifying the specific drivers of a malignancy. Increased testing is leading to the identification of novel fusions, which helps clinicians understand why certain cases do not respond to traditional therapies. Identifying specific alterations, such as TSC1 mutations, allows for the use of targeted drugs that are either approved as standard of care or available through clinical trials.

As data regarding high expression of specific markers becomes more available, antibody-drug conjugates (ADCs) are expected to become a pivotal therapeutic option for certain sarcoma subtypes. The ability to identify mutations such as TSC1 through advanced testing will be necessary to match the right patient with the right ADC.

Although genomic testing has great potential, Somaiah advocates for a balanced, cost-sensitive approach. Testing is most valuable when it has the potential to significantly alter the treatment course for advanced or unresectable disease. There are also limitations when tests are not sarcoma specific. However, as the spectrum of detectable alterations grows and more targeted drugs enter the market, the integration of genomic testing into routine sarcoma care is expected to intensify.