News & Information | START In The News

September 24th, 2010
San Antonio HCB Magazine

Start Center For Cancer Care To Offer Routine, Comprehensive Genomic Profiling Of Patients’ Tumors

START is the first center in South Texas to make this comprehensive testing routinely available to patients and other oncologists. Testing gives doctors new data for selecting targeted therapies and is being accessed by oncologists in other parts of the world.

The START Center for Cancer Care recently announced that they have begun offering cancer patients routine comprehensive genomic profiling of their tumors using a unique combination of technologies that includes chromosome profiling by array CGH (comparative genomic hybridization) and oncogene mutation analysis. START is the only center in South Texas to make this comprehensive testing of tumor tissue routinely available to its patients, and to make it available as a clinical test to any oncology patient being treated anywhere in the world. Patients do not need to be in treatment at START to have their tumors tested.

Genomic profiling looks at the tumor at the molecular or DNA level and represents a new tool for treating cancer. Clinicians and researchers alike believe that this new information will enable them to better direct patients to targeted therapies of both conventional and investigational drugs. It is considered a major step in the delivery of personalized medicine. But such testing of tumor tissue previously has not been readily available to cancer patients or oncologists.

The START Center is changing that. The new service will be coordinated through a new division called GenomeConsult at The START Center, and will be operated under the supervision of Shelly Gunn M.D., Ph.D. , a board certified clinical pathologist. The information her team provides will give oncologists important, otherwise unavailable data concerning the specific mutations and unique pattern of changes detectable in each patient's tumor.

START is the only local, private cancer center to have on staff a molecular pathologist. According to Dr. Gunn, “the arrangement is really quite unique.”

Dr. Gunn said that the START Center is “uniquely able to perform this testing which is now being routinely offered to patients at The START Center.” Gunn pointed out that, “You do not have to be a patient at START to use this service. It is available to any patient who requests it or for whom the oncologist feels it would be beneficial for prognosis and treatment planning.”

All human cancers are the result of changes to the normal DNA sequence and architecture. Newly developed molecular tools, combined with traditional pathology techniques, can now provide clinicians with a global genome view of abnormalities and mutations of chromosome architecture.

Genome profiling helps explain tumor causation, predict behavior and assist with treatment planning through the identification of therapeutic targets. Gunn and the doctors at START say that such precise data will help them select the best drug to target a patient’s particular tumor.

Lon Smith, president of the START Center said, "Genomic profiling confirms that the effort expended in the Human Genome Sequencing Project is beginning to bear fruit. Armed with information about the molecular machinery driving each individual tumor, we will have a new direction for treating resistant malignancies."

Dr. Anthony Tolcher, clinical director for START, said of the announcement, “We are making personalized medicine a reality right here in San Antonio.” START operates the world’s largest center for Phase I clinical trials for novel anticancer agents. Dr. Tolcher said, “Genomic profiling of tumors can detect amplifications and deletions of important oncogenes such as HER2, EGFR, and PTEN, and many of these genes are the targets of new therapeutic drugs.” He continued, “In fact we have several patients who have exhausted all standard therapies and Dr. Gunn can perform comparative gene hybridization that helps direct patients to the best clinical studies for their specific molecular markers.”

According to Dr. Gunn, “We can obtain a tumor genome profile for a patient anywhere in the world and issue a report to the patient's home town oncologist as long as we have access to the tumortissue that was preserved after surgery or biopsy. In fact,” she said, “We already have had many patients referred to us from other oncology groups in Texas and throughout the USA, and we are also beginning to receive samples from Mexico and other parts of the world.” She said, “We recently analyzed a tumor genome from a breast cancer patient in India.”

Barbara Trevett, a patient at START, was diagnosed with ovarian cancer in late 2004. She has enrolled in several clinical trials and endured various traditional chemotherapy treatments. Today she is enrolled in a Phase I clinical trial at START, specifically selected in response to the results of her genomic profile. "Just a few years ago, there were really no viable treatment options for women like me with ovarian cancer. The standard treatment involved harsh chemotherapy that didn't provide long term responses.” Trevett said, “New targeted therapies, based upon a better understanding of genetics, provides me with a better quality of life and a promising chance for recovery." She said, "This is a real breakthrough and to think it is happening right here in San Antonio speaks volumes for the quality of cancer care at START."

When a test is ordered through GenomeConsult, the blood, bone marrow, or tumor tissue sample is obtained from the patient during an office visit with their personal physician or at the time of biopsy or surgery. The patient sample is sent to Combimatrix Molecular Diagnostics (CMDX) a CAP/CLIA certified clinical laboratory in Irvine, CA where DNA-based genomic testing is performed. Test results are transmitted electronically to GenomeConsult for interpretation and the patient report is prepared and signed by a board certified clinical pathologist. Throughout the testing process, the patient and their physician will receive personalized consultation services from our staff including sample tracking and interpretation of results.

A full genomic profile of a tumor costs approximately $2000. This includes CGH and oncogene mutation analysis. CGH analyzes the tumor chromosomes and costs $1500. Mutation analysis analyzes specific oncogenes and costs $500. Both tests are looking for "drugable targets" in the tumor genome.

Some insurance companies and Medicare are beginning cover the service. Personalized medicine is based on an understanding of the normal human genome as it was defined by the recently completed Human Genome Sequencing Project The gene-based knowledge and the biotechnology tools that were the result of this important project are becoming increasingly available to patients and their physicians through clinical laboratory DNA-based genomic testing. Physicians can now incorporate knowledge about the genome into diagnosis and treatment planning that is appropriate for each individual patient’s disease.