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Specialized Clinic Opens for Patients with Cancer of Unknown Primary

Posted Sep 04 2013 12:00am

It has been predicted that oncologists would soon define the scope of their practices on the basis not of the organ in which a tumor has arisen (e.g., lung, GI, hematopoetic) but rather on the genotype of a patient's cancer. For example, an oncologist might treat patients only with HER2/neu positive neoplasms. A similar pattern is now being seen in the way that hospitals triage and care for oncology patients. I posted a previous note about how the University of Michigan now has a clinic for high-risk prostate cancer patients (see: New Clinic for High-Risk Prostate Cancer Patients at the University of Michigan ). The same institution has just established a clinic for cancers of unknown primary (see:  Now open! New clinic focuses on cancer of unknown primary ). Below is an excerpt from the announcement:

A new clinic at the University of Michigan Comprehensive Cancer Center....will focus on patients with cancer of unknown primary, offering consolidated resources and clinical expertise in this rare, aggressive sub-type of cancer to provide the best options to patients. Working in coordination with the Cancer Center’s Mi-Oncoseq clinical sequencing program, patients will have access to complete tumor sequencing to identify the genetic underpinnings of their tumors. In the context of a specialized molecular tumor board, these data may allow oncologists to recommend specific treatments or clinical trial opportunities that are likely to offer better results. Cancers of unknown primary account for about 3% of all cancer diagnoses and inherently represent a poor prognosis.

Mi-Oncoseq is described as a service providing  personalized oncology through integrative high-throughput sequencing . This process is described in more detail in the following way:

[The University of Michigan is] enrolling patients with advanced or refractory cancer who are eligible for clinical trials. For each patient, we perform whole-genome sequencing of the tumor, targeted whole-exome sequencing of tumor and normal DNA, and transcriptome sequencing (RNA-Seq) of the tumor to identify potentially informative mutations in a clinically relevant time frame of 4 to 6 weeks. With this approach, we have detected several classes of cancer mutations including structural rearrangements, copy number alterations, point mutations, and gene expression alterations. A multidisciplinary Sequencing Tumor Board (STB) deliberates on the clinical interpretation of the sequencing results obtained. We then share this research information with the patient and their physician.

As an example of the level of specialization of this evolving genomics-oriented cancer care, whole-genome sequencing, targeted whole-exome sequencing, and transcriptome sequencing of the tumor is performed in a relatively short period of time to allow for modifications of therapy. Because of the complex nature of this testing, a specialized tumor board, the Sequencing Tumor Board (STB), has been organized. All of this means that there will soon be cancer patients and CANCER patients. It's the latter, with the most life-threatening lesions, who will be treated by a highly specialized subset of oncologists who are best able to interpret the genomic information. Such treatment will also be nimble, allowing for rapid changes in the therapeutic regimen if and when the tumor mutates and escapes from existing therapy.

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