A combination of new knowledge and innovation in testing and treatments has already altered the outlook for many breast cancer patients, and new discoveries – coming at an ever faster pace – are promising even better results.
With deeper understanding of cancer biomarkers comes a range of tests that potentially lead to better diagnoses or treatments. But how to provide a platform that can combine current and emerging tests, and correlate the findings with a clinically relevant prognosis? This is the challenge a new collaborative research study – a partnership between the Ontario Institute for Cancer Research (OICR), Queen’s University, Sunnybrook Health Sciences Centre and Thermo Fisher Scientific – is looking to tackle.
Lead researchers Dr. John Bartlett, director of OICR’s transformative pathology program, and Dr. Harriet Feilotter, Department of Pathology and Molecular Medicine at Queen’s University, are working with a new assessment tool that interrogates a wide range of genetic markers, and aims to link patients with the drugs or clinical trials that best fit their cancer profile.
Dr. Bartlett explains, “As the number of tests for gene mutations and gene changes in cancer is growing, it will become increasingly difficult to perform and evaluate them efficiently. For example, gene A may currently be tested with a test from company A while gene B is being tested with a test from company B.”
The study utilizes the Thermo Fisher Scientific’s Oncomine Comprehensive assay, which Dr. Bartlett calls “a one-stop shop that allows us to capture everything we know today that factors into the decision for the patient.”
Dr. Feilotter says using one assessment tool brings a number of potential benefits. “For example, when you test for 10 different biomarkers separately, you would need 10 pieces of the tumour.
And when a tumour is small, you might not have enough material,” she explains. “With this assay, we can test all 10 at the same time, using a very small piece.”
This is especially important at a time when diagnostic clinical laboratories are working on smaller samples due to less invasive biopsies and better diagnostic tools, which can lead to earlier detection and therefore smaller tumours, says Dr. Feilotter. “That’s good news from a patient’s perspective, but it’s more difficult for the lab to test less material for a growing number of biomarkers.”
Beyond providing a diagnosis, the results can also point to likely outcomes for the patient, says Dr. Feilotter. “In some tumours, [the assay] can tell us who’s going to respond to particular therapies.”
As an example, she mentions the gene HER2. If the gene has been amplified – having many copies present – patients will respond to a certain drug. But in cases where multiple copies of the gene aren’t present, the same medication won’t be effective. “Having this information can save patients from treatments that are unlikely to succeed,” she adds.
Dr. Bartlett believes that having the capability for analyzing a number of genes in one sequencing run not only assures coverage of today’s key targets, it also allows room for growth. “It includes things we might want to add for the short-term future and ensures we are ahead of the curve.”
And having more information at their fingertips can enable researchers to further their understanding of the unique characteristics driving a patient’s cancer, says Dr. Bartlett. “With increasing awareness about the complexity of cancer, we realize that we can’t use a one-size-fits-all approach; we have to go patient by patient, group by group,” he explains.
Yet while diagnosis and treatment are becoming more personalized, it’s also important to ensure that all patients across Ontario – no matter what physician or hospital they seek out – can expect a uniform approach, and Dr. Bartlett believes that using a single platform for multiple tests can bring that consistency.
“We’ve brought together an interdisciplinary team with the common vision to bring patients the best standards of care and fuel innovation,” says Dr. Bartlett.
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