Advanced Genomic Testing

Transcription:

Melanie Cole (Host):  Every cancer, like every patient, is different. Genomic tumor assessments help identify the DNA alterations that are driving the growth of a particular tumor. As we understand more about these gene mutations, we are better able to provide cancer treatment therapies that specifically target changes in the tumor's genomic profile. My guest today is Dr. Shayma Kazmi. She is a medical oncologist and hematologist at Cancer Treatment Centers of America. Welcome to the show, Dr. Kazmi. Tell us a little bit--people hear the word “genetics,” they hear the word “genomics.” Tell us a little bit about what this field of medicine is?

Dr. Shayma Kazmi (Guest):  Overall, there is some confusion regarding genetics and genomics. Usually, when you use the term genetics, it refers to a person's own genetic makeup and the increased, perhaps enhanced, risk of certain cancer development. So, we talk about genetic testing as identifying what mutations you might be carrying that might make you a high risk of developing certain types of cancers. When we talk about genomics, and the language is confusing, however, we are talking specifically about the makeup of the cancer that you might have and how that can get analyzed to look for potential treatment options.

Melanie:  So, genetics being the person's make up; genomics being actually the cancer's make up, yes?

Dr. Kazmi:  Exactly.

Melanie:  So, how do you study what makes up any particular type of cancer or tumor?

Dr. Kazmi:  Well, that has evolved significantly over the last few decades. What we used to do and what is still done, is analyze the source of the cancers. So, one of the first things we do is, we review the cancer under a microscope, which is called the “pathology review” and we ascertain where the cancer originated from, such as, is it a breast cancer or is it a colon cancer or is it a lung cancer? Thereafter, we have sub-classifications within the original tumor site as to whether it is a non-small cell lung cancer or whether it's a small cell lung cancer. Then, further on we have sub-classifications. This is important because clinical research thus far groups patients in these kind of classifications to figure out which treatment works best for these patients. Now, what's different on the horizon is that we are not just essentially cocooning ourselves into evaluating cancers based on the origin site or the organ of origination but we are looking to see which mutation--what is the genetic makeup of the cancer--that drives the cancer growth. That's really the cornerstone of genomic testing.

Melanie:  Who benefits from this type of advanced testing?

Dr. Kazmi:  Really, we hope that everybody with cancer benefits from this testing because, ideally, what it would allow us to do is find the driver mutations that confirm which mutations drive the cancer growth and, ultimately, come up with treatments that are honed specifically at these specific mutations and will have limited side effects because it doesn't, basically, kill the organism--the human being--as well, alongside which is what chemotherapy generally does. It affects everything in a person that's rapidly dividing and has a lot more toxicities. These specific anti-bodies or genomically targeted drugs have the potential of being less toxic.

Melanie:  Is this becoming more of a standard of care, Dr. Kazmi? Is this something that you would go to first or is it something that happens after other treatments and testings have not proven effective?

Dr. Kazmi:  The short answer is both because there are certain mutations and certain types of cancers where this has been so effective that it really had to be done first. For instance, for non-small cell lung cancers, specifically adenocarcinomas. If you have an EGFR mutation, then you really ought to get the targeted treatment first. If you have an ALK mutation, then you ought to have that genetically targeted drug first. However, this is not cornerstone for everybody else who may have mutations that we haven't quite figured out yet. So, there are a lot of mutations that either we have not studied in detail in terms of getting a particular antibody or there are a lot of mutations we don't even have a drug, even in production in any pharmaceutical company, to target yet. So, for a lot of cancers this still remains experimental and still remains in the research arena but for a lot of cancers right now, it's happening and it's frontline. We hope in the next couple of decades that it becomes more frontline for more of the cancers.

Melanie:  If you and your oncologist decide you are a candidate for genomic testing, how does that process work?

Dr. Kazmi:  Actually, it's very simple. The patients themselves just have to consent to that and, really, the biopsy sample that, hopefully, has already been ascertained is what's sent off to a particular genomic testing lab. There are many, many options out there. It's a matter of a preference either of the oncologist, of the surgeon or the patient and depending on that, it's sent off to this lab for analysis and results usually come back anywhere from 3 to 4 weeks thereafter.

Melanie:  So, not that really difficult. Now, just tell us what you're finding on the horizon in this field of advanced genomic testing?

Dr. Kazmi:  What's really exciting is the fact that we are no longer tied to just doing research on breast cancer drugs because somebody has a breast cancer, for instance. What’s exciting is that if you have a particular mutation and that mutation is often found in, say, melanoma and there is a drug for that BRAF mutation in melanoma patients that works wonders, patients with other cancers who might have that mutation have access to those drugs as part of clinical trials a lot sooner. Traditional clinical trials take decades and decades to result anything meaningful and that's very, very costly and also takes a very long time. For patients who really need the treatment here and now, that's a very frustrating ordeal. So, what we are finding is that a lot more options are out there. I think a lot of pharmaceutical companies are also making more of these targeted drugs. So, there are more and more options for clinical trials, too. So, it's really very exciting.

Melanie:  So, in just the last few minutes, Dr. Kazmi, if you would, tell the listeners what you really want them to understand about advanced genomic testing and why they should come to Cancer Treatment Centers for their care.

Dr. Kazmi:  The most important thing that I would tell a patient with cancer is, get all the information. Get second opinions or third opinions all the time. There is a lot, a lot, a lot of progress in the world of cancer literally every day and every week I find that a lot of patients come from areas where the doctors are not well-informed about the recent advances. So, I would recommend that they get second and third opinions. I would recommend that they understand as much as they can about their cancer and their potential treatment options and when they do, they basically should treat where they feel most comfortable.

Melanie:  Thank you so much for such fascinating information. You are listening to Managing Cancer with Cancer Treatment Centers of America. For more information, you can go to cancercenter.com. That’s cancercenter.com. This is Melanie Cole. Thanks for listening.