Molecular Screening and Therapeutics Study
Why is molecular screening important for cancer patients?
Advances in precision medicine mean cancer patients can now undergo genetic profiling of their tumour (currently on a research basis). This can indicate which potential treatments the patients’ are most likely to respond to, and those which are unlikely to help them. This enables oncologists to develop a personalised cancer treatment plan that will give their patients the best chance of a positive outcome or of avoiding treatments that are unlikely to work and which may have unwanted side effects (i.e.) to more ‘precisely’ inform your cancer treatment plan. A good analogy might be comparing a ‘one size fits all’ garment to a customised tailored suit.
Treatments possible include drugs that target a gene mutation(s) in an individual person’s cancer, immunotherapy (in which the patient’s own immune system is used to attack the cancer) or referral to an appropriate clinical trial.
Precision oncology has been particularly significant for older patients, and those with advanced stage cancers and/or rare cancers who have not responded to standard therapies and have very few other treatment options.
It is important to be aware that not all patients may benefit from tumour profiling; that is, not all will have ‘actionable’ variants found in their tumour DNA. We have found that some degree of actionability is reported in about 45% of referrals, however this comes with a certain level of confidence that the proposed, matched treatment will be effective. A tier-based classification system is sued to express such levels of confidence.
This is a very complex area with many clinical logistical and other considerations including drug availability and tolerability. It is therefore critical that the results of a patients’ tumour profiling are discussed with a multi-disciplinary team at an MPCCC-based Molecular Tumour Board (MTB) meeting to best inform the patients treatment plan .
A Molecular Tumour Board (MTB) meeting is a forum for discussion by a multi-disciplinary team of patient’s individual tumour profiling results in the context of their ongoing treatment. The MTB brings together the referring oncologist, other oncologists who specialise in the type of tumour that the patient has (e.g. lung, breast); molecular and anatomical pathologists, researchers, research and cancer care nurses, radiation oncologists and others. All provide input from their area of expertise to the best treatment for that particular patient(s), taking many factors in to consideration. The patient needs to consent to their case being discussed at an MTB. There is much evidence to show that this sort of discussion amongst a multi-disciplinary team provides marked improvement overall to the patients’ treatment plan and overall disease management.
How is MPCCC providing patients access to molecular screening?
MPCCC has entered into a research Collaboration Agreement for the Pilot Phase of the ‘MoST’ study. “MoST” is an acronym for the ‘Molecular Screening and Therapeutics Clinical trials and immunotherapy study’. The MoST study is one of several studies undertaken by the Australian Genome Cancer Medicine Centre (AGCMC) based at the Garvan Institutes’ Kinghorne Cancer Centre in Sydney.
This collaboration enables the MPCCC’s Precision Oncology Program (POP) to act as a central co-ordination hub for patient referrals from within the MPCCC catchment area to the AGCMC’s (MoST) study. Co-ordination by the MPCCC is particularly important since MPCCC affiliate hospitals are spread across a wide geographical area of the South to South East of Melbourne and includes Alfred Health, Cabrini Health, Monash Health, Epworth Health, Peninsula Health, Eastern Health and Latrobe Regional Health, extending down to Wonthaggi Hospital. It is impossible for the AGCMC to manage recruitments from this large number of widespread health services, so the MPCCC plays a key role in providing a single point of contact for the AGCMC for patient recruitment from the SE Melbourne catchment.
Via this collaboration, Next Generation Sequencing (NGS)-based comprehensive genome profiling (CGP) of tumours is conducted at the AGCMC, and complex sequencing data analyses are run. Each case and tumour profile is discussed at the AGCMC’s internal MTB meetings by a team of oncologists, researchers, pathologists and bioinformaticians, enabling expert data curation and ‘interpretation’ of genetic variants identified by tumour profiling. That is, the matching of potential therapies to pathological variants, using an evidence-based system using a tiered classification system for ‘Levels of Confidence’.
The MPCCC POP works with referring clinicians from MPCCC-affiliate health services to facilitate the patient recruitment process and help co-ordinate retrieval of archival tumour biopsy material from pathology service provider, ensuring that the appropriate histopathology report for an individual is sent along with the MoST study referral forms, ensuring that all data on the referral form is complete, keeping a register of referrals and ensuring that the referring oncologist receives the final Molecular Report from the AGCMC. The POP also hosts tumour stream-specific MTB meetings within its catchment.
How Monash affiliate health services can access molecular screening through:
To find out more, contact the Program Manager Ms Vikki Marshall on Vikki.firstname.lastname@example.org.