Treating cancer at the molecular level
The Power of Advanced Medicine
The future of cancer treatment is fighting the disease at the level of an individual gene, breaking down a diagnosis by analyzing each patient’s unique genetic characteristics. At the UK Markey Cancer Center, our Molecular Tumor Board is leading this fight, bringing personalized, precision medicine to patients across Kentucky.
The Molecular Tumor Board, which is made up of more than a dozen leading clinicians and scientists, meets monthly to review individual cancer cases from across the Commonwealth, diving deep into patients’ genetic information, then collectively tailoring a precision treatment specifically for them.
Tailoring a Precision Treatment
“It’s well accepted that cancer is chiefly a genetic disorder,” says Dr. Jill Kolesar, a founding member and co-director of Markey’s Molecular Tumor Board. “The first genome that was sequenced took 13 years and $2.7 billion dollars. Now we can sequence a genome in an afternoon.”
Such significant advances in technology have helped spur precision medicine, but have also created large quantities of genetic information, Kolesar said. It’s up to the Molecular Tumor Board to interpret that vast amount of data and apply it to an individual’s cancer diagnosis and treatment.
Medical oncologist Dr. Susanne Arnold, Markey’s associate director for clinical translation and member of the Molecular Tumor Board, is helping lead this individualized approach to cancer treatment. A precision approach to diagnosis and analysis is the future of care, she said.
“You take a biopsy and do the genomic analysis, called next-generation sequencing, which helps us understand exactly what happened with that cell that resulted in cancer,” she explained.
But what might sound like a routine test in modern medicine is much more remarkable in these particular cases.
“Molecular medicine is actually discovering the information about a unique cancer in a specific person at a precise point in time,” she said. “Pinpointing this allows us to understand why it happened, why our treatment did or didn’t work, and how we can potentially stop (the cancer).”
In short, these tests allow for a remarkably detailed understanding of what goes wrong in cancerous cells. And that sort of comprehensive knowledge helps the tumor board choose the best treatment from among the many options available at the UK Markey Cancer Center.
How the Molecular Tumor Board Works
Markey’s Molecular Tumor Board is not the first of its kind, but it is the first in Kentucky. And that’s significant, given the unprecedented rates of cancer across the state, most notably in the rural, eastern parts of Kentucky.
With the board meeting twice monthly, oncologists across the state can reach out for a recommendation for therapy based on their patient’s molecular signature.
The Molecular Tumor Board is a group of scientists, clinicians, pharmacists, and other cancer experts – biologists, radiologists, pathologists – who work together to digest the information gleaned from molecular testing into a manageable prognosis, diagnosis and recommendation for therapy. – Dr. Susanne Arnold
There are more than a dozen scientific specialties represented on the board, and more than 300 years of experience in total. All of this is applied to a single patient as cases are presented to the board, and the inclusion of each patient’s own physician in the process ensures an intimate understanding of that patient’s condition and outlook.
Each patient’s cancer will be tested for all genetic mutations that are known to cause cancer, regardless of what type of tumor the patient has. The tumor board then uses the results of that test to choose possible treatment options that target the genetic mutations. Each mutation is evaluated for FDA-approved therapies for the patient’s tumor type, FDA-approved off-label therapies and any clinical trials available related to the patient’s specific mutations.
Taking into consideration the available treatment options, the Molecular Tumor Board will make a recommendation based on the best possible outcome for the patient.
For a Single Patient, For All of Kentucky
As more tumor boards are established across the country and more cases are reviewed, a bank of information will be available to doctors to help them determine the best course of action for patients with similar cases.
“Everything we discover is designed to help you, and by sharing this information in an anonymous way, it can help people across the country suffering with cancer. We’re all being connected through this process, and that’s a beautiful, beautiful story to tell,” Arnold said. “Imagine you are ‘Anne’ from Pikeville, Kentucky, but behind you is your doctor, the Markey Cancer Center, other NCI-designated cancer centers, the National Cancer Institute … and ‘John’ in New York City, who has the same mutation as you. The six degrees of separation suddenly disappear, and ideally you each benefit from the experience of the other.”
That is the crux of Markey’s ambitions: an individualized approach to each patient, but on a large scale. In an open letter released at the end of 2016, Dr. Mark Evers, director of Markey, made public a goal of the organization: to significantly reduce cancer incidence and mortality across the state, and the region, by the year 2020. It’s a lofty aspiration, but initiatives like the Molecular Tumor Board position Markey for success.
As Kolesar said, “When researchers and clinicians at the Markey Cancer Center decide something is going to benefit patients, like the Molecular Tumor Board, they say, ‘Let's do it.’”
This team spirit spans the entire organization. Kolesar noted the collegiality and support for accomplishing goals at UK HealthCare.
“Dr. Evers, says, ‘You just tell me what you need, and we'll make it happen, because that's what we think the patients of Kentucky need,’” she said.
Such sweeping change, especially when it comes to issues as complicated and extensive as healthcare, rarely happens quickly. But a series of small successes, over time, can have an enormous ripple effect. The experts who make up the Molecular Tumor Board understand this, and it’s their reason for participating in and offering their time to such programs.
“By understanding the genetic makeup of our patients and their tumors, we can then help to direct their therapy,” Evers said.
The Future of Advanced Medicine
Treatment options at UK HealthCare are more abundant than ever before. The Early Therapeutics Clinical Trials Center focuses on increasing patient access to phase I and phase II clinical trials will also have a major impact for Markey patients.
“[Previously,] if patients in Kentucky needed an earlier-phase clinical trial, they would have to go out of state,” said Kolesar, explaining the advantage of the initiative.
These early-phase studies can offer patients new treatment avenues for cancers that have proved difficult to target using standard therapies. Essentially, it allows Markey to participate in the development of new and novel treatments while offering patients first access.
Being at the forefront of medicine means incredible discovery, but for every breakthrough, there are new unknowns. This uncharted territory is a product of advancement and a reason for optimism.
“Do we have a therapy for every gene that’s broken? No. But we do have therapies for genes that are broken in non-small cell lung cancer, melanoma, breast cancer, colon cancer and a growing list every day. They are defined by their gene signature and by the gene that’s broken. That’s called targeted therapy,” Arnold said.
The hope is that this sort of targeting can be applied to all types of cancer, and Markey’s patients could be among the first to benefit.
“The Power of Advanced Medicine” is more than a slogan. It’s a guiding principle and a reminder that UK HealthCare prioritizes discovery in the name of our patients.