What is Precision Medicine?

DNA illustration Instead of a “one size fits all” approach, precision medicine drills down to the tiniest of details when it comes to examining molecular and genomic information. The aim is to identify changes and patterns in individual cancers that may influence therapy outcomes. This form of research can yield treatment options for those patients whose cancer is not responding favorably to standard therapy.

At Rutgers Cancer Institute of New Jersey investigators are working on a genomic analysis study which could illuminate more options in developing personalized and precise treatments for cancer patients. It is believed that some rare and resistant cancers that have limited treatment options may harbor genomic changes that can potentially be treated with specific targeted therapies. Through Next Generation Sequencing and data analysis of DNA in tissue samples, researchers aim to identify these changes in order to guide treatment. And thanks to a $10 million anonymous gift, a collaborative effort between the Cancer Institute of New Jersey and RUCDR Infinite Biologics® within the Human Genetics Institute of New Jersey at Rutgers will be enhanced, allowing investigators to identify the drivers that make a tumor cancerous, and target therapies to these abnormalities in a more rapid fashion than ever before.

As part of the genomic analysis clinical trial at the Cancer Institute of New Jersey, a detailed analysis of tissue samples is conducted to determine exact gene abnormalities potentially responsible for their cancer. The goal is to pinpoint what drives the growth of cancer cells. This analysis includes targeted Next Generation Sequencing, which examines more than 200 genes, in which findings of specific abnormalities may predict the vulnerability of individual cancers to specific targeted treatments.

Shridar Ganesan, MD, PhD, a medical oncologist and associate director for translational science at the Cancer Institute, is leading the clinical trial. “In recent years we have learned that cancers that arise in one organ, such as breast cancer or lung cancer, are not just one disease, but rather a collection of distinct diseases with varying responses to different treatment strategies. We therefore need to examine many features of each cancer to better classify it and identify effective treatment,” notes Dr. Ganesan.

Unlike previous genomic analysis efforts at the Cancer Institute, which have taken six or more months to complete, advances in Next Generation Sequencing technology have improved turnaround time and reduces that time to one month or possibly less. This type of response enables investigators to put theory into practice almost immediately. If certain biomarkers or “drivers” are identified through the process, the findings are discussed at a weekly meeting of the precision medicine tumor board, which is comprised of clinicians, basic scientists, systems biologists and those with computational expertise. The team can then decide quickly if the sequencing results suggest new therapy options, which could include enrollment in a clinical trial that is testing a novel drug.

“This rapid shift from laboratory bench to patient bedside is a hallmark of the expertise and resources found at a National Cancer Institute-designated Comprehensive Cancer Center such as Rutgers Cancer Institute of New Jersey,” Lorna Rodriguez, MD, PhD director of the precision medicine initiative at the Cancer Institute. “This approach gives clinicians an opportunity to offer new treatments or guided enrollment into clinical trials in a timely fashion and ultimately improve outcomes for our patients,” she adds.

Because of rapidly improving technology, genomic analysis -- which includes more in-depth scientific examination in the context of precision medicine -- is quickly becoming a mainstay in cancer research and is an area in which the Cancer Institute is on the cutting edge. In identifying what drives cancer cells, we potentially shift the focus of how cancer is classified. Instead of determining cancer type only by the organ in which it originates, genomic analysis opens the door for additional classification by the set of genomic changes present in each cancer, which can be more precise and guide therapy.

Based on the results of the genomic analysis study, the precision medicine team aims to develop clinical trials targeting specific genomic changes in a given cancer instead of relying only on organ-based classification.