The way Jill Kolesar describes it, standard care for cancer has been like carpet bombing, fighting tumors with big blasts of chemotherapy and radiation. But now, she’s helping start the University of Kentucky Markey Cancer Center’s newest weapon, which finds its target more like a drone.
“There has been a big technology explosion,” said Kolesar, who was recruited from the University of Wisconsin two months ago to start Markey’s first molecular tumor board, an innovation in cancer care that is spreading across the country. She’s directing the board along with Rachel Miller, a gynecologic oncologist at Markey.
The “board” is literally that: a group of experts gathered around a table. Whereas doctors used to treat cancer based on where it was in the body, they can now look at the genetic mutations that caused the cancer to figure out the best ways to treat it.
Lung cancer is often used as an example, partly because Kentucky has the country’s highest rate of incidence and death from it. So a doctor might request that a patient diagnosed with lung cancer be reviewed by the tumor board. The patient’s biopsied tissue from the tumor will be tested for mutations using what’s known as “Next Generation Sequencing.” Pathologists will compare the patient’s genes against a panel of 198 gene mutations associated with all types of cancer.
The report on the mutations will be sent to the board, which is made up of oncologists, surgical oncologists, pathologists, basic epidemiologists, and clinical pharmacologists, such as Kolesar. They will evaluate the results for three types of care: FDA-approved therapies, possible off-label therapy and potential clinical trials. For example, if the patient has three mutations, any of which might have caused their cancer, there may be drugs that target each or all of the mutations. Sometimes, there’s nothing and the board will recommend standard therapy.
“We now have these new drugs that are more effective and less toxic because they target the mutation in the tumors,” Kolesar said.
Co-director Rachel Miller calls the board “the essence of precision medicine.”
“The Molecular Tumor Board provides not only an opportunity for our patients, but also an opportunity for a physician to gain a better understanding of these molecular characteristics, while providing the latest in optimal care for our patients,” she said.
It will also get a boost from the recent 21st Century Cures Act, a bipartisan bill passed by Congress and signed by President Barack Obama on Dec. 13. It provides $6 billion for biomedical research, with nearly $2 billion for cancer research alone. That money will flow through the National Institutes of Health to researchers at universities all over the country, including UK. UK President Eli Capilout was present at the Senate vote to pass the bill.
One person who is particularly excited about the tumor board is Jamie Studts, a behavioral science professor who directs Markey’s lung cancer screening program.
“All of this comes together to change the face of lung cancer, not just in Kentucky, but in the nation,” he said. “Our society has resigned itself to suffering, but these innovations can contribute to changing our attitude to optimism.”
As it starts, the molecular tumor board will review about eight patients a month. It’s expensive, and some insurance plans don’t cover genetic testing. But Kolesar said that the approach is sure to expand as it helps patients and informs research at the same time.
“Understanding the mutation landscape of our patients is informing our drug development and we think it will speed things up,” Kolesar said. “One goal is to take this to the entire state so everyone in Kentucky has access to precision medicine.”