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Clinical utility of genomics in management of advanced solid cancers

Clinical utility of genomics in management of advanced solid cancers

Background

Melbourne Genomics’ Clinical Flagships have been at the forefront of determining when genomic testing makes a demonstrable difference to the safety and quality of patient care. The Advanced Solid Cancers Flagship is one of 16 clinical projects conducted by Melbourne Genomics.

Tremendous insight has been gained into cancer in recent decades by investigating how genetic changes in cells drive tumour growth. Detailed understanding of an individual’s cancer is now providing the opportunity to apply treatments targeted to specific gene changes.

Genomic sequencing in advanced solid cancers may lead to more accurate diagnosis and personalised treatments.

Project description

The objective: to determine if the use of genomic testing1 is possible within the current infrastructure of the cancer care system in Victoria, and if it can improve clinical care.

Patients from five metropolitan hospitals in Victoria were involved. Archival tumour tissue and a new blood sample were collected upon patient enrolment into the Flagship.

Matched tumour-normal samples were tested, analysed and reviewed by a panel of experts including oncologists, molecular pathologists, genomic scientists, bioinformaticians and geneticists.

The Advanced Solid Cancers Flagship2 was led by Dr Jayesh Desai and Professor Stephen Fox from the Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, with key coordination from
Dr Kortnye Smith of the Peter MacCallum Cancer Centre. The Flagship involved at least 19 healthcare and research professionals in Victoria.

Activities, outcomes and lessons learnt

Findings from this project will be made available following publication of results.

Impact

Multidisciplinary variant review meetings introduced for this Flagship have now become integrated into testing conducted for clinical care and clinical research at the Peter MacCallum laboratory.

Clinical Flagship team




Name

Organisation

Role

Jayesh Desai

PeterMac/RMH

Medical oncologist

Stephen Fox

PeterMac

Pathologist

Kortnye Smith

PeterMac

Medical oncology fellow

Andrew Fellowes

PeterMac

Chief Scientist, Molecular Pathology

Andrew Schmidt

Austin Health

Medical oncologist

Andrew Weickhardt

Austin Health

Medical oncologist

Ben Markman

Monash Health

Medical oncologist

Ben Solomon

PeterMac

Medical oncologist

Ben Tran

PeterMac

Medical oncologist

Carmel Murone

Austin Health

Site coordinator

Clare Scott

PeterMac

Medical oncologist

Damien Kee

PeterMac/RMH 

Medical oncologist

Dong Anh Khuong Quang

RCH

Medical oncology fellow

Grant McArthur

PeterMac

Medical oncologist

Hui Gan

Austin Health

Medical oncologist

Lindsay Thompson

Monash Health

Site coordinator

Paul Ekert

MCRI

Paediatrician/Researcher

Rachael Chang

Austin Health 

Medical oncologist

Sophie O’Haire (née Beck) 

PeterMac

Project manager

To further evaluate genomic testing for paediatric advanced cancer, members of the Flagship and the Melbourne Genomics evaluation team are collaborated with Dr Maria McCarthy – building on an existing research grant from Cancer Australia that she holds exploring decision-making and perceptions of genomics’ value in paediatric advanced cancer.

Health economic evaluation for this Flagship was led by Prof Paula Lorgelly, King’s College London and Monash University. A discrete choice experiment was conducted in collaboration with James Buchanan, University of Oxford.

 

1 The Flagship team used a comprehensive cancer panel (~400 genes) for testing patients with solid cancers.

2 This Flagship was a joint endeavour between Melbourne Genomics and the aligned national initiative, Australian Genomics. This summary presents findings from the Flagship’s Victorian patients.