Indiana University Researchers Find Precision Medicine Improves Outcomes

Milan Radovich, PhD, and Bryan Schneider, MD
Published: Friday, Oct 14, 2016
Milan Radovich, PhD
Milan Radovich, PhD
Assistant Professor
Surgery & Medical and Molecular Genetics
IU School of Medicine
Breast cancer researcher, IU Simon Cancer Center
Co-director, IU Health Precision Genomics Program
Bryan Schneider, MD
Bryan Schneider, MD
Associate Professor
Medicine & Medical and Molecular Genetics
Vera Bradley Investigator in Oncology, IU School of Medicine
Breast cancer researcher, IU Simon Cancer Center
Director, IU Health Precision Genomics Program
Strategic Partnership
Given that cancer at its essence is a disease of DNA, driven by mutations in tumor suppressors and oncogenes, genomics-based precision medicine is a natural fit for oncology therapeutics.

In patients with metastatic disease where options are typically limited, genomic analysis is frequently being used in standard clinical settings to identify alterations, which are potentially actionable with FDA-approved drugs or clinical trials.

With the growing body of evidence supporting positive outcomes with the use of precision medicine–based approaches, academic cancer centers are increasingly incorporating genomic technology into standard clinical care.

In 2014, the Indiana University Health Precision Genomics Program was initiated to provide cutting-edge genomic analysis for patients with metastatic, refractory, or rare solid tumors.

The program is operated as an outpatient referral service where, on the initial visit, patients are provided an introduction to precision medicine and cancer genomics; a history, physical, and informed consent are obtained; and either existing tissue is procured or a new tumor biopsy is performed. The service then utilizes a combination of whole-genome sequencing, whole-transcriptome sequencing, and proteomic analysis to provide a comprehensive molecular portrait of each patient’s tumor.

A molecular tumor board composed of oncologists, scientists, pharmacists, pathologists, genetic counselors, and bioethicists reviews each patient’s results to derive a therapeutic plan. Patients return to clinic to receive a layman’s education on their genomic results and counseling for the drugs that are recommended and/or logistical support for pertinent clinical trials. All results and recommendations are subsequently conveyed to their primary oncologist.

Genomic Analysis Improves Outcomes

Our group recently published our experience from the first 101 patients enrolled in the program (Radovich et al. Oncotarget; 2016). The majority of patients had a diagnosis of soft tissue sarcoma, breast cancer, pancreatic cancer, or colorectal cancer, although multiple other tumor types were included.

Our efficacy analysis demonstrated that 43.2% of those patients who received genomic-guided therapy had improved progression-free survival when compared with their own prior therapy versus only 5.3% of those who did not receive genomic-guided therapy (P <.0001).

Of note, the majority of patients had seen at least 3 prior lines of therapy. These results demonstrate that a significant clinical benefit can be obtained with the use of genomically directed therapy in a heavily pretreated patient population.

In an effort to continue to advance the application of precision medicine beyond metastatic disease and into the curative setting, our group launched a first-of-its-kind clinical trial in patients with triple-negative breast cancer who have residual disease after neoadjuvant chemotherapy (NCT02101385).

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