The genomic profile of a lung tumor opens new doors for its treatment

By Harala Halevi. Content promoted in cooperation with Roche, a representative of FoundationOne.

Nati's battle with cancer that plagued the family began a year earlier, when Nati's sister died of stomach cancer at the age of 36. When the family heard that there were tests that could match the treatment more precisely to the tumor Nati's sister had, it was already too late. Four months after her death, it turned out that Nati's father was also ill. He was found to have a lung tumor, stage 4, which had spread and metastasized. It was clear to Nati that this time the fight against cancer would start differently, so he asked for a comprehensive genomic test to more accurately adjust the treatment plan that would be given to his father. "My goal was to find out which mutations caused the cancer that developed," said Nati, "so that we could adjust the treatment to the mutations that caused the tumor to develop, and not according to the common protocols."

The genomic test identified a number of biomarkers (biological markers) in the tumor that were responsible for its development, and based on this a targeted immunotherapy type of treatment was adapted. Two months after the start of the treatment, Nati's father underwent his first imaging test. "I will never forget the meeting with the oncologist who told me that father was tumor-free," Nati said excitedly, "Today, two years later, my father continues to receive treatment and the imaging tests show that he is cancer-free. He lives a normal life and raises my sister's children. Thanks to the test we did, we managed to save dad, and dad got his hope back.'

Nati's father is one of hundreds of patients in Israel who are treated today with a "personalized medicine" approach, in contrast to the approach according to which treatments are given according to the type of cancer (lung, breast, bowel, etc.), the treatment is targeted and given based on the genetic profile of the specific tumor.

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The crystal ball of cancer treatment

Tests that diagnose the genetic profile of the tumor today reveal information that until a few years ago was not taken into account in cancer treatment decisions. As cancer research progressed, researchers realized that genetic mutations and other biological processes play an important role in the development of the disease. For example, there are genetic mutations that allow cancer cells to escape the immune system and prevent it from eliminating them. These discoveries have allowed researchers to develop newer drugs that target these mutations and thus prevent the tumor from continuing to develop. Biological therapy targeting genetic mutations, and immunotherapy, which increases the immune system's ability to recognize and eliminate cancer cells, are examples of these innovative treatments.

These treatments are given with or without chemotherapy and sometimes have different (and milder) side effects. But for targeted treatment to be effective, two important conditions are required: the first is to locate the mutations that caused the development of the particular tumor and the second condition is to find which targeted treatment is suitable for that mutation. This information can be obtained through genomic testing.

Genomic tests perform an in-depth scan of dozens of genes in the tumor, and their goal is to identify the mutations in the tumor and match them with targeted treatment. These tests can reveal treatment options for patients who carry certain mutations in different types of cancer, including lung cancer. For example, mutations in EGFR, which can be found in some lung tumors, may indicate suitability for targeted (biological) treatments aimed at this mutation. On the other hand, a mutation in the MET gene in the same tumor would suggest that the tumor would be resistant to this type of treatment.

Genomic tests to detect specific mutations are performed as a routine in hospitals, and they can simultaneously scan for mutations in dozens of key genes related to cancer. When the tumor develops or is widespread, the doctor sometimes recommends a comprehensive genomic test, which, unlike the routine tests, scans a significant part of the genetic material in the tumor, and can locate hundreds of genes at the same time and all the mutations that are relevant to the development of the tumor.

FoundationOne is an example of a comprehensive genomic test that simultaneously scans 315 genes and can identify the cancerous mutations in a tumor that are known today to drive the cancer. This test provides oncologists with comprehensive information about the patient's genetic makeup, and informs him which drugs may be suitable due to the specific change found. These drugs can be those approved by the FDA to treat the patient's specific cancer, drugs approved for other diseases, or drugs that are in research stages suitable for the tumor being tested. As part of this test, information is also obtained on other biomarkers such as mutation load (TMB) or genomic instability (MSI), which predict the likelihood that the patient will respond to a certain immunotherapy treatment. A genomic test gives a clear picture of the genetics of the tumor, which allows for an informed treatment decision based on the most information about the molecular properties of the tumor.

In November 2017, the US Food and Drug Administration (FDA) and the government insurance program of the US Department of Health and Welfare (CMS) announced in a joint announcement the approval and recommendation for coverage of FoundationOne CDx for patients with advanced cancer, thus making the test the only comprehensive test approved by the FDA as a diagnostic tool for adjusting targeted treatment in cancer

Comprehensive genomic testing is not yet part of the treatment standard in hospitals and can only be performed in a private setting. There is partial coverage by some of the funds and broader coverage by the private insurances depending on the type of policy.

Ask your doctor about the FoundationOne test. For details click here>>>

* The article was written in collaboration with Roche, a representative of FoundationOne, and is offered to readers as marketing content