Clinical Genomic Testing Program Expands Personalized Treatment for Cancer Patients

Cancer treatment has become much more sophisticated and individualized in recent years. Since each person’s cancer has its own genetic signature, one person’s lung or breast tumor, for example, may grow at a different rate or respond better to certain treatments compared to someone else’s lung or breast tumor.

At the heart of those differences is the genetic makeup of the cancer and learning what is driving the growth of that cancer – a certain mutation – can be determined through genomic testing, also known as molecular profiling. With that information, doctors may be able to match a personalized treatment that is targeted to the patient’s cancer and likely to provide the best prognosis. There are currently more than 50 FDA-approved targeted therapies available, and many more are in clinical trials.

“Genetic testing is important in two ways,” said Carol Farhangfar, Ph.D., assistant vice president of Translational Research at Atrium Health Levine Cancer Institute (LCI). “If we find a mutation that matches a targeted drug or trial available, the tumors are more likely to respond to a targeted therapy than to generalized chemotherapy. If we don’t find a mutation, it’s equally important because it means that we will know what drugs will not work well, saving the patient from potential side effects and an additional financial burden since targeted drugs are expensive.”

How Genomic Testing is Done

If a patient and their oncologist decide that genomic testing is appropriate, a biopsy is taken of the tumor and is sent to a lab to reveal the genetic make-up of the cancer cells. Today, with next-generation sequencing, thousands of genes within the tumor are evaluated, looking for specific targets. Testing also can be performed using a blood sample. The results provide a roadmap that can enable doctors to prescribe a personalized treatment based on the cancer’s DNA.

Targeted therapy with new cancer treatments can take different forms, including shutting off a protein that is driving the cancer growth or interrupting a specific signalizing pathway within the cell. It is revolutionary compared to standard chemotherapy that was not specific to a particular target on the cancer cell.

Expanding Availability of Genomic Testing

It often takes time for advances in personalized medicine to be adopted and become available to all the people who could benefit from them, so leaders at LCI wanted to close that gap. They implemented a clinical genomics program to standardize and centralize all of the functions required to obtain and use genomic testing for cancer patients at all LCI locations, urban and rural, throughout the health care enterprise.

Initially, in 2010 - 2014, genomic testing was primarily performed by a select group of physicians early in their careers at Atrium Health Carolinas Medical Center but, after the innovative program to expand its use was implemented in 2015, genomic testing increased 11-fold and the number of physicians offering testing to determine treatment for their cancer patients increased 10-fold.

Today, more than 8,000 patients have had genomic testing at Levine Cancer Institute. It is offered by physicians at all experience levels – even those with more than 30 years in practice – throughout all 30 LCI locations. Those physicians are supported by specialists who are part of LCI’s molecular tumor board, including oncologists, genetic counselors, pathologists and pharmacists, and also by technology that matches patients to clinical trials of therapies suitable for their specific cancer characteristics.

While large, academic cancer centers offer widespread genetic testing, that is not usually the case with community health systems.

“What is unique is how we implemented it,” Farhangfar said. “We wanted to make sure that, regardless of where our patients were, they would have access to the testing and we would also provide support for the physicians to make it easy to navigate the system to get it done.”

Another key priority was to work with testing labs to make the cost of the testing more affordable to patients.

“I do believe that other health systems could emulate this,” she added.

More patients matched to clinical trials

Clinical trials offer opportunities for patients who may not have other treatment options.

When a mutation found through genetic testing does not have an FDA-approved targeted therapy, it’s possible that a clinical trial of a new therapy may hold promise.

Significantly, 15% of LCI patients who had genomic testing from 2015-2020 were matched to a clinical trial and, among those whose results were reviewed by the molecular tumor board, the clinical trial accrual was 28%.

Broadening availability of new cancer treatments

Nationally, a smaller percentage of Black and Hispanic patients were offered genetic testing. However, once LCI’s new system was put in place, minority representation for those tested within the health system was similar to its patient population as a whole.

“It’s important to have broad representation in clinical trials from patients throughout our communities and provide them with equal access to the most innovative testing,” said Farhangfar. “There are some molecular differences among people from different backgrounds due to their genetic makeup. The more we learn, the better we will become at developing personalized therapies that provide the best chance of cure for our patients.”

LCI’s Molecular Tumor Board has increased the ability to make novel targeted treatments accessible to underserved populations, which is directly in line with LCI’s mission and vision of building a cancer center without walls, providing the highest level of care to all patients, regardless of where they live.

Results of Levine Cancer Institute’s program to increase genomic testing were published July 15, 2022 in the Journal of Clinical Oncology’s Clinical Cancer Informatics.