What is Precision Medicine?
In precision medicine (or precision oncology), doctors choose treatments that are uniquely targeted and effective based on your genetic makeup. Some healthy people inherit genetic alterations that increase their risk of cancer. If you have one of these alterations, your doctor can develop a strategy based on your genetic alteration and risk for specific cancer for cancer screening and prevention. People who have already developed cancer often have alterations in genes in the tumors that drive growth of the cancer. If doctors can discover the specific genetic alterations in your tumor, they can customize treatment to target your cancer's specific genes to slow or prevent progression (precision oncology). By finding the Achilles’ heel of your tumor, precision oncology maximizes the likelihood of success and avoids therapies that are unlikely to work.
How does it work?
Deoxyribonucleic acid (DNA) is a molecule that records our genetic code and contains the instructions to build our bodies. Genes are made up of linear sequences of the four building blocks (nucleotides) of DNA, or bases. An organism’s complete set of genes is called a genome (humans have about 20,000 genes). Variations in gene sequence that can be harmful are known as mutations. While many variations are harmless, some mutations put people at higher risk to develop certain cancers. Cancer cells have acquired mutations that allow them to grow uncontrollably. However, some of these same mutations also make cancer cells uniquely susceptible to specific drugs. This susceptibility allows targeted therapy to be applied — choosing a specific treatment that targets the cancer’s particular pattern of mutant genes and proteins.
A data plot generated by UW-OncoPlex showing changes in the number of copies of genes within tumor cells (referred to as copy number variation).
In addition to detecting mutations in the DNA of genes, UW-OncoPlex also detects differences in the number of copies of genes—a number that is important for deciding which cancer therapy to choose. For example, certain cancer types have many copies of a gene called ERBB2 (also known as HER2); these cancers are susceptible to drugs that target the HER2 gene. The data plot above shows numerous copy number changes, including copy gain of the CCND1, WT1, KRAS and MDM2 genes (in the top middle of the plot) and copy loss of CDKN2A (p16) and MAP2K4 genes (at the bottom of the plot) among other changes.
What is UW-OncoPlex and what will it tell me about my cancer?
Until recently, clinical labs could only test for a few mutations at a time. But now, high-speed gene sequencing machines in clinical labs can read the sequences of hundreds of genes at once. As such, researchers at UW Medicine developed UW-OncoPlex, a diagnostic test that identifies mutations in a set of about 200 genes. Many of the mutations found by this approach can determine how to choose an FDA-approved drug or a therapy already in clinical trials. By testing for thousands of possible mutations all at once, UW-OncoPlex can identify the specific mutation signature of each cancer.
With the results from UW-OncoPlex testing, your doctor can choose the most effective treatment for your individual tumor. This can spare you the physical and emotional wear and tear of treatments that don’t work. The time factor is important as well. Cancer left untreated tends to grow, spread and spread to other kinds of tissue. By attacking it with one or perhaps more of the effective agent(s) right away, there’s a better chance to contain the cancer and force it into remission.
Why is UW-OncoPlex Uniquely Beneficial for Patients with Rare Cancers?
UW-OncoPlex can be particularly helpful for patients with rare forms of cancer or rare tumor types. For example, if a treatment is known to be effective in only four percent of patients, it usually is used only as a last resort. But with the availability of UW-OncoPlex, statistics for the entire patient population are irrelevant. What matters is how a patient with a particular genetic variant will respond to each treatment. When the response can be predicted by genetic testing, UW-OncoPlex may give doctors a scientific basis for prescribing a “low odds” therapy as the first line of treatment — for individual patients.
Is UW-OncoPlex right for me?
UW-OncoPlex is a powerful test that is not currently recommended for all cancer patients. Please review your individual situation with your physician to decide if UW-OncoPlex is the right test for you at this time.
How do I get tested?
Your doctor can order UW-OncoPlex the same way he or she orders other laboratory tests. The testing laboratory will work with your care team to obtain a suitable sample of your tumor tissue to test. Once a suitable tissue sample has been received in the laboratory, it takes approximately eight weeks to complete the test and interpretation. Your doctor will receive a complete test report, and the test results (on approximately 200 cancer-related genes) are put into your medical record. A Laboratory Medicine physician and pathologist will be available for individual consultation with your doctor about how to interpret and use your test results for your optimal medical care.
What does UW-OncoPlex mean for the Future of Precision Medicine at UW Medicine and the SCCA?
With the introduction of UW-OncoPlex, Renato Martins, M.D., M.P.H., said that UW Medicine and SCCA are “now second to none in the genetic profiling of cancer cells.” The power of UW-OncoPlex is that it leverages capabilities across the entire UW/SCCA health system. As Dr. Colin Pritchard, one of the lead developers of the test, explained, “We start with high-quality diagnostics. Then you add in excellent clinicians who are on top of all the literature and know how to interpret the data. You also need a stable of high-quality drugs in development and trials showing that these drugs work — validating whether or not the UW-OncoPlex results correctly predict patients’ responses. You need to have all these pieces in place.” With these tools, people and processes in place, UW Medicine and the SCCA are uniquely positioned to deliver the kind of precise and effective care to people with cancer that we have hoped for during the last generation. It has finally arrived.
If you would like to learn more about the advancement of cancer cures and treatment for patients with solid tumor cancers, the
Solid Tumor Translational Research group strives to increase collaboration and further treatment in this area.