Dall’Olio FG, Conci N, Rossi G, et al. - In a retrospective cohort of advanced non-small-cell lung cancer – adenocarcinoma (NSCLC-A) patients treated at the Sant'Orsola-Malpighi University Hospital to compare the efficacy, costs, tissue consumption, and time between a sequential single-gene testing algorithm vs next generation sequencing. Out of 1,758 patients that were included in the study, 1,221 were characterized with the sequential algorithm between January 2014 to February 2019 and 537 with Next Generation Sequencing (NGS) until January 2020. A similar prevalence of EGFR, ALK and KRAS alterations was seen between the stepwise and NGS group. Higher prevalence of ROS-1 rearrangements was observed in the stepwise vs the NGS group (4.7% vs 0.7%). A higher prevalence for MET amplification, MET mutations, HER2 amplification and mutations, and BRAF mutations was seen in the stepwise group vs NGS. Per patient cost of sequential testing was 1,375 € vs 770 € for NGS. In addition, NGS testing can be done with just a 25 µm slide vs an estimated 33.3 µm slide for sequential strategy. For patients with NSCLC-A, experts concluded that NGS, in comparison with sequential strategy, affords a less costly and more reliable model of diagnosis.