Over the past 20 years, cancer care has been revolutionized by precision therapies, offering new hope — especially for patients with advanced cancer.
Chemotherapy used to be the only option to slow or stop the spread of cancer cells from the tumor site to other parts of the body. These drugs work by killing rapidly dividing cells — including cancer cells and many normal cells.
Today, more than 40% of the new cancer drugs approved by the U.S. Food and Drug Administration are precision therapies. These drugs work by zeroing in on specific genetic mutations that drive a tumor’s growth, helping slow or stop the cancer.
“We were one of the pioneers in this area…and the genomic oncology program is incredibly important because these targeted medications improve outcomes and quality of life.”
Tatjana Kolevska, MD
To learn if a cancer patient might be a candidate for a targeted therapy, a piece of their tumor must be sent for genomic testing. This is now typically done with next-generation sequencing, an advanced technology that tests for many mutations at one time.
Kaiser Permanente Northern California launched its Next Generation Sequencing/Molecular Profiling Program for Precision Oncology in 2017. Since then, more than 33,000 cancer patients’ tumors in Northern California have been tested.
“We were one of the pioneers in this area,” said Tatjana Kolevska, MD, a medical oncologist and the medical director for the Kaiser Permanente National Excellence in Cancer Care Program and the National Virtual Cancer Center. “Our care model is always focused on the patient, and the genomic oncology program is incredibly important because these targeted medications improve outcomes and quality of life.”
The testing program is the largest known community-based precision oncology and genomic testing program in the U.S. Each month, about 550 patients’ tumors are tested shortly after a patient’s initial diagnosis.
Test results are sent to the region’s Genomic Oncology Tumor Board. This team of experts develops personalized treatment recommendations for each patient based on which — if any — known mutations are driving the tumor’s growth. The recommendations could vary from a specific targeted therapy to a clinical trial. A recent analysis of theprogram found that nearly 22% of patients had tumors with genomic alterations that could help guide treatment decisions. Another 14% had findings that could potentially qualify them for a clinical trial.
If the test identifies a potentially inherited genetic mutation — the type of mutation that can be passed down from a parent to a child — the patient is referred to a genetic counselor to discuss potential inherited cancer risk. About 8% of patients whose tumors are tested fit in that category.
“This program is vital for our patients,” said Sachdev P. Thomas, MD, regional clinical lead for Genomic Oncology, and a co-director of the Next Generation Sequencing/Molecular Profiling Program. “Any patient whose physician requests the test will have their tumor tested.”
Advancing cancer research
The program allows oncologists to enroll patients in some of the largest and most significant cancer clinical trials in the U.S. It also creates important research opportunities for investigators at the Kaiser Permanente Division of Researchand for clinicians. To date, more than 2 dozen genomic oncology studies that have used data collected in the program have been published in medical journals or presented at national oncology meetings.
“We are able to study and track genomics-based outcomes in ways that many other cancer programs can’t,” said Lori Sakoda, PhD, a research scientist and a co-director of the Next Generation Sequencing/Molecular Profiling Program. “The studies we conduct will continue to shape the field of precision oncology.”
As new targeted therapies continue to be developed, researchers and physicians expect the program to grow and develop and to create new research opportunities.
“The genomic oncology program is a great example of a successful collaboration between Kaiser Permanente’s clinical oncologists and researchers,” said Research Scientist Laurel Habel, PhD, a former co-director of the program. “By bringing together a range of expertise in cancer diagnosis, treatment, and clinical trials, along with database development and research, we have been able to improve care for all cancer patients.”
