Dr. Lillian Siu, CGP Executive Director, and Dr. Phillipe Bedard, CGP Clinical Director, discussing patient data
The Cancer Genomics Program, under the direction of Dr. Lillian Siu, Dr. Philippe Bedard and Dr. Suzanne Kamel-Reid, works with medical oncologists at Princess Margaret Cancer Centre to provide molecular profiling services for their patients free of charge. The team consists of oncologists, research scientists, research coordinators, research assistants, and lab technicians dedicated in advancing research in cancer genomics. In 2012, CGP opened its first comprehensive molecular profiling study, IMPACT (Integrated Molecular Profiling in Advanced Cancers Trial)(opens information in a pop-up overlay)
IMPACT: Integrated Molecular Profiling in Advanced Cancers Trial
Eligible cancer types: Breast, Colorectal, Non-small cell lung, Gynecological, Upper Aerodigestive Tract, Pancreatobiliary, Genitourinary, Unknown Primary, Rare Cancers
In March 2012, IMPACT was launched as a pilot study at the Princess Margaret Cancer Centre. This study involves the molecular profiling of archival paraffin-embedded tumour tissue for Princess Margaret patients with advanced breast, colorectal, non-small cell lung, gynecological, upper aerodigestive tract, pancreatobiliary, genitourinary, unknown primary, and rare cancers, as well as patients with melanoma and phase I trial patients who are candidates for systemic therapy. The primary objective of IMPACT is to provide the treating clinician with molecular profiling information for their patients that may be used to guide treatment and/or clinical trials with matched targeted therapies in the future. Results of molecular profiling are included in patient’s medical records. Through large molecular profiling initiatives such as IMPACT, the goal is that new knowledge can be gained about the genetic alterations or changes in cancers which affect their clinical outcomes and responses to drug therapies.
The Role of Oncologists
Medical oncologists and their fellows identify suitable patients for profiling and approach them directly in their clinics. Once the testing is complete, the profiling results are returned to the oncologists directly, and are made available in the patient’s University Health Network medical records.
The oncologists may utilize the results to guide treatment by identifying patients that may benefit from a targeted treatment. Oncologists involved in the molecular profiling initiative meet regularly at a Genomics Tumor Board to discuss any complex cases, and review new topics related to cancer genomics.
Bringing in the Community
In November 2012, the CGP molecular profiling initiative was expanded to community hospitals in Ontario through the parallel arm of the IMPACT study, called COMPACT (Community Oncology Molecular Profiling in Advanced Cancers Trial)(opens information in a pop-up overlay)
COMPACT: Community Oncology Molecular Profiling in Advanced Cancers Trial
Eligible cancer types: Advanced breast, colorectal, non-small cell lung, gynecological, upper aerodigestive tract, pancreatobiliary, genitourinary, unknown primary, rare cancer
In November 2012, COMPACT was opened as a parallel arm of the IMPACT study to make molecular profiling available to patients who are receiving their cancer treatment at other Greater Toronto Area hospitals. These patients are referred to the Princess Margaret by their community medical oncologists for participation in this study. A rotating roster of three staff oncologists (Drs. Lillian Siu, Dr. Philippe Bedard, and Dr. Albiruni Razak) assess and consent patients who have been referred to the Princess Margaret for molecular profiling. COMPACT patients remain under the care of their referring physicians. All COMPACT molecular profiling reports are sent to the treating medical oncologist with additional information regarding what is known about detected mutation(s) and available clinical trials with matched targeted therapies when standard of care therapy is no longer effective.
Since opening IMPACT, CGP has opened up many more molecular profiling studies. The CGP team meets regularly to discuss the status of current studies, to develop and validate innovative molecular profiling techniques, and to address scientifically relevant questions in cancer genomics. CGP works closely with the clinical Advanced Molecular Diagnostics Laboratory and the research-oriented Pugh Lab to be able to provide the latest technology in molecular profiling services to cancer patients.