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The Promise of Precision Cancer Treatment | Presented by CTCA and Foundation Medicine

The Promise of Precision Cancer Treatment | Presented by CTCA and Foundation Medicine

It’s like finding a needle in a haystack. Dr. Miller:
The human genome has more than 20,000 genes and we believe that about 300 of those
are intimately involved in cancer. With genomic sequencing,
we can look for the true Achilles’ heel of a cancer to identify treatment options allowing the doctor to plan treatment, not like a fire drill,
but more like a chess game. Dr. Chura:
We typically use genomic testing for patients where our
treatment options are limited or the standard therapies have already not been successful. And that was certainly
the case for Christine. Christine had advanced recurrent clear cell cancer of the ovary, an unusually aggressive
and rare histology. Christine:
I was diagnosed in 2010. I was 30 years old. Over the course of three years, I had had multiple surgeries, radiation and chemo. Every time I thought
I was in remission, it reappeared somewhere else. At one point I was told that I had probably
one month of life left. My husband was the one
that said,”No, no, no.”“We’re not going to
give up on this yet.”When I first met with Dr. Chura, his goal was to get me
back into remission. Dr. Chura:
Clear cell ovarian cancers are a rare histology and we often don’t know
what the best treatment is, especially in the recurrent setting. That’s where genomic testing
comes into play. Dr. Elvin:
At Foundation Medicine, we sequence over 300 genes simultaneously
from a patient’s tumor sample. We have spent a lot of time
developing a process that we have extensively validated to make the results as accurate
as scientifically possible. In Christine’s case, we saw
an activating mutation in the PIK3CA gene, and an inactivating mutation
in the protein PTEN, which is a negative regulator
of this pathway. Just identifying the gene mutations
isn’t enough. We’re able to contextualize
the mutations that we found within the most extensive database of molecular information
that’s out there. We compared around
160,000 patients, of which, about 20 had
a combination of mutations that were extremely similar
to Christine’s case. We can then put this information
into the context of the medical literature to identify additional therapy options. Dr. Chura:
Christine’s FoundationOne® report allowed us to identify an
alternative treatment for Christine, not found on the NCCN guidelines. We elected to go with
an mTOR inhibitor, a drug much more commonly used
for renal cell carcinoma. Christine:
Within three months, I received a report
that was clear. On her mTOR inhibitor,
Christine has had over three and a half years
of progression-free survival, with minimal side effects
and an excellent quality of life. Christine:
Now, I can actually plan. I can live further out than
just the next couple of months. Dr. Chura:
With ovarian cancer, typically each remission gets successively
shorter and shorter. We’ve actually changed the
natural history of her disease. That’s remarkable. Dr. Elvin:
Dr. Chura reported back how exceptionally well
she was doing on the therapy. Being able to get this feedback
will allow us to learn and help physicians make
better suggestions for the next patient with
a similar molecular profile. Dr. Chura:
With each FoundationOne® test that we order, our understanding
of cancer grows. It’s amazing to think that one day
we may speak of a cancer with a PTEN/PIK3CA mutation. Who cares where it came from, it’s the mutations that
we are going to target. We’re going to improve
our survival, we’re going to improve
our cure rates, and allow our patients
to live much better lives.

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