Expert Discusses Significance of Roche/Foundation Medicine Collaboration

Andre Goy, MD

Earlier this week, Roche announced plans to acquire a majority stake in the molecular testing company Foundation Medicine for $1.03 billion to create a partnership focused on developing personalized medicine for patients with cancer.

Andre Goy, MD, chairman, director, and chief of the Lymphoma Division at the John Theurer Cancer Center, sat down with OncLive to discuss the recent merger and what that means for the future of precision medicine.

Can you discuss the importance of precision medicine and Foundation Medicine’s role in this venture?

Foundation Medicine is one of the diagnostic companies that is using massive parallel sequencing and next-gen sequencing to try to look broadly at the genome. This is important for several reasons. The Human Genome Project has obviously had a huge impact in oncology. We now better understand the molecular diversity of cancer. Cancer is an accumulation of mutations that drive the cells to become a cancer cell, but they differ enormously from one cancer to another, even within one type of cancer.

With the progress of understanding the cancer biology, at the same time we have developed more targeted therapy and novel therapy. What is challenging is to try to identify how we match those and how we identify the best treatment for each patient. It could be regular chemotherapy or it could be novel treatment.

Foundation Medicine is one of the early diagnostic companies that have used this technology to look broadly at several hundred genes. So now their signatures are close to 600 genes that they are looking at to try to identify the landscape of a tumor. This is done, practically, out of a fraction of a tissue from the paraffin section from the original biopsy. Through the technology, it takes 2 to 3 weeks and you get a result that gives you a landscape of the predominant anomalies and the goal is to try to see if there is something that can be used as a marker of a driver of a cancer cell to use either for treatment with approved agents or for a clinical trial.

For example, lung cancer used to be “one-size-fits-all” for chemotherapy. Now, there are 14 mutations that are important to try to identify to change the treatment, so we look at the genetic defect to try to pick a novel therapy instead of chemotherapy.

For patients who have failed all standard therapies and for which there are no other approved treatments, we like to identify some of these mutations that can sometimes give us a driver that we can target with a novel therapy.

Another implication that is also important is to identify which patients are responding early on so you can pick the patient for a clinical trial and give them the right drug earlier instead of looking at all the patients.

This effort of precision medicine is very important and many diagnostic companies are looking at this to try to help oncologists make better decisions. The problem that we face is that this is still somewhat fishing for abnormalities and the yield is sometimes difficult and it’s an expensive process but there is no question this is where the field is going.

What do you think the partnership between Roche and Foundation Medicine means for community oncologists?

So now with the joint venture with Roche, which is the largest drug manufacturer of cancer drugs, this is going to be a huge push to try to identify areas for diagnostic development, to try to identify signatures, and try to characterize early on a subset of patients who can either benefit from experimental therapies or an agent that is already approved.

This is going to help, hopefully, if we can continue this effort, to develop both for standard therapy but also for novel therapies and drug development.

What do you think are the next steps for the collaboration?

When you characterize a cancer, you look at the staging, you do blood work, scans, etc, and you try to make a recommendation. So now, we are looking at the abnormalities of cancers to help make a decision but this is still not enough, given the diversity of cancer.

It is sometimes difficult to have enough tissue or to have the tissue available and when someone relapses, they are not always rebiopsied.

So what’s going to be really exciting, and one of the major benefits of this collaboration, is the ability to start moving toward the next technology, which is either going to be naked DNA or circulating tumor cells (CTCs). CTCs can be detected early on in a large number of cancers and they are obviously not very numerous, but if you can detect those cells, develop a technology that can be used in the peripheral blood, this will have a huge impact for early diagnosis of recurrence, early diagnosis in general, and for looking at responses while a patient is receiving treatment.

So I think we’re moving away from the tissue itself to try to have a less invasive and easy-to-use technology on a plethora of patients.

Can you discuss your experience working with Foundation Medicine’s products?

We have a joint venture with Foundation Medicine to provide data for the Cancer Outcomes Tracking & Analysis System. This system works perfectly with Foundation Medicine’s approaches to try to stratify patients based on the ultimate molecular characterization at the time. So we enter patients in this database at diagnosis with the standard clinical markers and we are working with Foundation Medicine to build up the molecular markers.

We want to be able to monitor our patients better and try to look at the evolution of these patients and see if we can, for example, at the time of either relapse or diagnosis, alter our treatment decision and tailor the treatment based on that. That’s where the field of oncology at large is moving and I think it’s a really exciting time because it will help us design smaller clinical trials that will be molecularly relevant.

In order to do this, you need to have a large population of patients and collaborate together to try to look at a molecular defect and try to identify a subset of patients that should be treated differently.

How do you see this partnership impacting personalized medicine as a whole?

I think this is going to be a huge push. Because molecular technology is evolving quickly, tests are quickly becoming outdated. This makes it difficult to penetrate clinical care and make this a habit of the physician.

Having a very large drug manufacturer, such as Roche, to try to push this effort of molecular diagnostics will be very meaningful. A number of other companies are looking across the board at different approaches and platforms to try to identify better signatures to allow physicians to make more rational decisions from the get-go.

I think the collaboration is really going to change the field dramatically and bring things to the next level, given the scale of the project.