Sanford Health studying impact of precision medicine cancer treatments

Sequencing tools analyze unique genetic information

The genetic makeup of cancer cells often can be a factor in determining a patient’s best treatment options. Patients at Sanford Health with advanced or rare forms of cancer are being invited to enroll in a new study to further explore potential benefits of genomic profiling.

“The idea we are trying to look at here comes from current, scientific technology in the field of genomics. We have had a lot of advances in the last decade or so in our knowledge of genetics,” said Dr. Sam Milanovich, an oncologist and cancer researcher at Sanford. He is leading the COMPASS trial with Dr. Steven Powell at Sanford.

The COMPASS study will employ the latest genetic sequencing to personalize cancer treatments. The purpose of the study is to determine how many patients get a targeted treatment or end up in clinical trials, Milanovich said. The study group will be followed over several years to examine how technology is applied and how it is improving treatment options.

COMPASS, which stands for Community Oncology use of Molecular Profiling to personalize the Approach to Specialized cancer treatment at Sanford, follows on the heels of the GEMMA pilot study. GEMMA enrolled 120 Sanford cancer patients who had genetic testing done. The study demonstrated molecular profiling increases awareness of clinical trial and off label treatment options for patients with incurable cancer.

“Most cancer is the result of genetic mutations or genetic problems that arise in a cell or tissue,” Milanovich said. In the GEMMA study, most patients had a particular DNA mutation or characteristic associated with their cancers that, at least in theory, could be targeted with specific medications, he said.

Forty percent of GEMMA participants were able to get that type of treatment and 17 percent were admitted into clinical trials. Not all patients might be suited for a targeted treatment based on a variety of factors, including whether physicians find conventional treatment a better option.

At Sanford, patients with rare cancers or whose cancers have persisted despite standard treatment are offered genetic testing.

“We encourage all patients, if they are getting this testing done, to be enrolled in this trial,” Milanovich said. In participating, patients might have an additional laboratory test done but would not need to change their Sanford doctor and would continue to receive the same level of care.

Data from the genomic profiling is viewed by the Sanford Genomic Tumor Board to help guide the decision process for the treating cancer team, patient and family. The committee is a panel of cancer and genetic experts from across Sanford.

In some cases, targeted treatment leads to a greater success rate in eliminating cancer or sending it into remission. Along with better outcomes, though, targeted treatment can result in a better quality of life, Milanovich said. Identifying medicines that can target certain mutations can lead to treatment that avoids toxicity to normal tissue and carries fewer side effects.

Physicians already are using DNA information to guide the choice of treatment for some mutation types. However, there are more mutations that need to be studied.

Genetic testing and targeted therapies are newer in the field of pediatric cancer treatment, Milanovich said.

“There’s not as much out there, so it’s too early to say how many patients are going to find targets using this kind of approach in pediatrics. That’s part of why we want to include children with cancer in this trial. We can learn how to apply this kind of technology to kids with cancer. Pediatric cancers are often different than adult cancers,” he said.

“I think this will be significant at helping us learn about some of our difficult to treat pediatric cancer patients,” he added. “We have come a long way over the years by enrolling a lot of children and their families in clinical trials. We have many patients now who have a very high likelihood of getting a long-term remission of their cancer with conventional treatment, but we still have many that don’t. This trial will really help us learn more about what is the genetic makeup of some of these tumors and see how using this technology can help improve their outcomes.”

Adding to the medical mystery is the ability of cancer cells to evolve and find ways around targeted treatments.

“That’s the challenge in applying this targeted therapy to get better long-term responses,” said Milanovich, who noted the most effective treatments will continue to be a combination of therapies.

For more information or to enroll in the COMPASS trial, call 877-652-1838.