Precision Medicine at Scale is Here

Lucio N. Gordan, MD

Precision oncology, or personalized medicine, uses sophisticated genomic testing to identify a person’s cancer cells. With this information, physicians can make an exact diagnosis and prognosis and plan treatment that targets a specific tumor with great precision. Dr. Lucio Gordan has spearheaded efforts to establish next-generation genomic testing capabilities in-house at FCS. The statewide practice expanded its state-of-the-art Pathology Laboratory in Fort Myers in 2021 and is providing patients with clinical next-generation sequencing (NGS) for testing solid tumors, hematologic malignancies and lymph nodes.

A Board-certified medical oncologist, one of Dr. Gordan’s dreams is to make sure that patients are appropriately tested as much as possible. “Internalizing genomics within FCS was a tool to accomplish that,” he said.

Inhouse genomics brings several key elements for patient care. Among them:

• Decreased turnaround time, which reduces the stress of waiting for testing results.
• Faster development of targeted treatment plans and the ability to match patients with the latest FDA-approved drugs and available clinical trials.
• Robust data collection about patients’ cancer journeys, which yields valuable insights into the best therapies and informs clinical research.

Access to genomic testing has historically been limited to patients being treated in academic settings. Yet, with the majority of cancer patients (estimated at 70% nationwide) receiving care in community-based oncology clinics, FCS’ goal is to make this innovative research tool part of routine practice in the community setting.

“Developing NGS capabilities inhouse was mission critical to democratize access to testing,” said Dr. Gordan. The years-long process involved capital investment, industry partnerships, equipment acquisition and validation, the hiring of expert molecular scientists and setting up a bioinformatics division. Having the equipment and knowledge “will culminate into increased testing rates and with that good things start happening to match right therapies to the right patients.”

Thirty-five to forty percent of all cancer patients in Florida receive their care from FCS, according to Dr. Gordan. “If we are able to get 90+% of patients tested appropriately, it will change the outcomes, improve quality of life and eventually decrease cost of care by enabling us to choose the right therapy for the right patient as fast as possible.”

Dr. Gordan says it was not difficult to convince the practice’s 250+ physicians and 300+ advanced practice providers that genomics would be a tremendous benefit for patient care. FCS physicians are getting “much more in tune” with the process and Dr. Gordan says it is paying off. “Our testing rate has risen year-over-year and this makes me very proud.”

Barriers do exist and the quest has not been without challenges. Much is required beyond establishing the complex sequencing capabilities, such as the coordination of patient access, reimbursement, health record integration, community awareness and patient education.

The largest struggle hampering the expanded use of genomic profiling, according to Dr. Gordan, is payor coverage. “That should not be a matter of discussion, but we still have problems,” he noted.

Yet, despite the headwinds, Dr. Gordan says FCS is holding steadfast to its vision. “More and more broad testing will equal more opportunities for matching the right drug to the right patient and for specific clinical trial matching.”

What will precision medicine look like at FCS’ nearly 100 community clinic locations in the future? “It will be standard technology that will bring hope, optimism, cure, decreased cost and suffering and better treatment,” Dr. Gordan said.

Partnerships with Illumina and other industry-leading partners will remain a vital component as FCS increases the scalability of its in-house laboratory capabilities. Enhancing its rigorous data governance program plays a key role, as well. “We want to be able to match the patient journey to genomics,” Dr. Gordan explains. “That will be very powerful for understanding cancer behavior, for clinical trial matching and real-world studies. I am very bullish and excited about that!"