Genomic profiling is approved by the FDA to help guide cancer treatment and clinical trial enrolment for cancer patients. Among other things, this approval allows the genetic test, F1CDx (FoundationOne CDx), to be used as a companion diagnostic test for 15 different targeted therapies used to treat five types of cancer.
What is Genomic Profiling for Cancer Treatment?
At its most basic, genomic profiling involves testing a patient’s genes – aka tumour DNA sequencing – to identify the exact genetic mutations that are driving that person’s form of cancer. After we identify the person’s genetic mutations, we find a targeted therapy to match. In other words, we find a drug that’s designed specifically to kill the patient’s exact genetic mutations. Not all genetic mutations have targeted drugs designed for them, but many do and that number is growing quickly.
Targeted therapies have fewer, and less severe, side effects than standard cancer treatments, such as chemotherapy. This is because targeted therapies only kill the cancerous cells, while leaving the healthy cells alone to flourish. Standard treatments like chemo, however, kill ALL rapidly reproducing cells in the person’s body, not just the cancerous ones. This can cause severe damage to one’s body, in addition to many destructive side effects.
How Genomic Profiling Improves Cancer Treatment Success
Take a look at this useful table, which illustrates different targeted therapies and their matching genetic mutations & cancer type. Scroll down to the bottom of the page to see the table.
Research published earlier this year showed that targeted sequencing (aka MSK-IMPACT test) identified actionable genetic changes in 37% of patients with advanced solid cancers. An actionable mutation is one that can be targeted with either an approved drug or one that’s being tested in clinical trials.
In other words, these genetic tests are now required tests in order to get a prescription for certain targeted drugs. For example, if you have breast cancer and the genetic panel determines that you have a HER2 (ERBB2) genetic variation, you would be eligible to get one of the three targeted therapies listed (Trastuzumab (Herceptin®, Ogivri™), Pertuzumab (Perjeta®) or Ado-Trastuzumab Emtansine (Kadcyla®)) and/or to enrol in a clinical trial for one of these drugs.
This is great news for many cancer patients since it allows them access to drugs proven to be more effective for them than standard treatment. Patients with a variety of rare but actionable mutations “really add up to a significant subset,” said Marc Ladanyi, M.D., chief of molecular diagnostics. He also points out the big win for everyone with these genetic panels:
“It would never be cost-effective to screen for these alterations one at a time, but using a panel makes the whole proposition work. We’re able to identify these patients and get them into trials, most of which have been quite successful at showing improved outcomes.”
Not only does this mean that more patients now have more access to targeted therapies and clinical trials but it’s further proof of the ongoing integration of precision oncology into standard treatment.
Tumour DNA Sequencing: Targeted Sequencing versus Whole Gene Sequencing
We’ve mentioned two names of genetic panel tests in this article: MSK-IMPACT and F1CDx. These are types of Tumour DNA Sequencing tests, which can also be called genetic panels. Genetic panels look at a person’s tumour tissue (biopsy) and identify mutations in the genes. This data then helps us determine the best targeted therapy for your form of cancer.
There are two types of Tumour DNA Sequencing panels, targeted and whole gene. Here are the differences:
Targeted sequencing (MSK-IMPACT): This type of panel only looks at specific regions of the DNA. Further, it only looks for “actionable” mutations that we currently have targeted drugs for. This is less thorough than whole gene sequencing and, as such, it’s cheaper than a whole gene sequencing panel.
Whole gene sequencing (F1CDx): This type of panel looks at ALL the mutations in a gene, and it looks at ALL the genes – regardless of whether or not they’re actionable (i.e. unknown mutations). Having information about a person’s unknown mutations is important for two reasons:
a) We can do a computer analysis of your unknown mutations. This allows us to determine useful information about the nature of the mutations and provides evidence-based data for choosing the best targeted drugs. (As well as information on whether chemo, radiation, and other therapies are likely to be effective or not.)
b) Because new targeted therapies emerge every day, it often happens that a mutation that’s unknown today becomes an actionable mutation 3 months down the road or even sooner. When we have data on ALL your mutations ahead of time, we can jump on clinical trials or new drugs as soon the opportunity arises.
How to Access Genomic Profiling for Your Cancer Care
As you can see, Tumour DNA Sequencing is highly valuable. It’s an essential part of an accurate diagnosis and effective treatment plan for any type of cancer, at any stage. If you’d like to access Tumour DNA Sequencing to determine exactly what’s driving your cancer, contact CTOAM today.
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