Some of the newest and most exciting cancer drugs target tumors that have a specific genetic mutation or characteristic. These targeted therapies block the growth and spread of cancer by interfering with specific molecular targets on those tumors that are involved in the growth, progression and spread of cancer.
As more and more of these targeted therapies come to market, and as older targeted therapies are approved for new indications, oncologists have been ordering comprehensive genomic profiling tests (also called next-generation sequencing or NGS) for an increasing number of their patients with metastatic cancer.
NGS testing is possible from tumor tissue or routine blood draw, and which type of NGS test is ordered depends on many factors including disease type and individual patient circumstances.
Testing is almost exclusively, however, used to guide management of patients with advanced cancer and in later stages of therapy.
Right on Target
Precision cancer medicine is a high priority initiative in Duke Cancer Institute’s strategic plan. Two years ago, DCI partnered with the Department of Pathology and DUHS Clinical Laboratories on a groundbreaking Precision Cancer Medicine Initiative (PCMI).
The initiative’s four faculty leaders John Strickler, MD (Solid Tumors); Matthew McKinney, MD (Hematologic Malignancies); Michael Datto, MD (Molecular Diagnostics and DUHS Clinical Laboratories); and Shannon McCall, MD (PCMI Research Initiatives) are maximizing the organization, availability, and interoperability of cancer patients’ clinical and tumor genomic information for the benefit of cancer care and research with an increasingly active weekly Molecular Tumor Board (MTB) and a growing Molecular Registry of Tumors.
For patients with “solid tumors,” such as colon cancer, breast cancer, or lung cancer, a screen for as many as 400 genomic alterations is critical, explained Strickler. These genomic tests, he said, might identify a rare "needle in the haystack" that predicts extraordinary response to novel therapies, or identify patients who would benefit from immunotherapy. With the aid of this testing, patients with advanced cancer can avoid toxic treatments with limited benefit, and potentially identify non-toxic therapies with extraordinary benefit.
When tumor tissue is either not available or the tumor’s mutations have “evolved” in response to treatment, a liquid biopsy can screen for up to 73 clinically relevant genomic alterations.
With rapidly evolving cancer breakthroughs and diagnostic technology, all of this testing requires a strategic partnership with leading private diagnostics companies. The MTB team has identified the most innovative and reliable partners to bring cutting edge NGS testing to Duke patients.
As the test results come back to the ordering physicians, they’re inputted into the Frameshift Molecular Registry of Tumors (Frameshift MRT) by Datto, who, with DUHS clinical informatics architect Chris Hubbard, designed, built, and coded the secure electronic registry. Datto hoped it would be a “robust entity” and it has already delivered.