The principle of precision oncology is to give the right drug to the right patient at the right time by using genomic profiling of the tumour to guide treatment. While next-generation genome sequencing technologies are increasingly used in clinical research and to select patients for clinical trials, they are not yet well-integrated into routine clinical practice.
The VCCC Precision Oncology Program has implemented a groundbreaking approach whereby genomic testing is based on clinical decision-making rather than the strict eligibility criteria required for research studies or clinical trials. Since March 2019 this approach has enabled VCCC alliance hospital partners to provide some patients access to genomic testing they would not otherwise have had.
New approaches for rare cancers
So far genomic testing has been conducted for more than 200 patients with a broad range of different cancers, with around half considered to be rare tumour types.
Whole-genome sequencing considers the entire genome, whilst targeted sequencing focuses on a panel of genes with known relevance to cancer. The choice of technology is made based on patient circumstance and tissue availability. A third of the patients were referred for whole-genome sequencing while a further two-thirds were referred for targeted sequencing.
Evidence-based data emerging
To date, 166 patient samples have been processed through the full genomic testing ‘pipeline’, from consent to the final report. For around 60 per cent of patients, genomic data yielded clinically useful findings. In more than 40 per cent of these, treatment-targetable alterations were identified, and in around 15 per cent, the genomic test results offered diagnostic information.
Focussing on 99 patients able to be followed up for 3 months post-test result, 51 per cent of clinicians reported that useful information was gained from genomic testing which informed future treatment options and clarified the diagnosis.
The Precision Oncology program has recently expanded to leverage the introduction and validation of technologies that allow genomic profiling from circulating tumour DNA (ctDNA) in blood, otherwise known as a “liquid biopsy”.
VCCC Molecular Tumour Board
The VCCC Molecular Tumour Board (MTB) is a multidisciplinary style forum that brings together both clinicians and scientists to provide opinion on the clinical interpretation and implications of molecular pathology test results of tumours.
The MTB has proven to be an essential component of the genomic ‘pipeline’ described. It also provides a regular, real-time opportunity to discuss and consider scientific and clinical issues with the aim to improve genomic literacy for healthcare professionals. If you are interested in participating in VCCC MTB meetings or would like to refer a case for discussion, please visit the VCCC MTB web page for more information.