A genomic test at an innovative new biolab ensured that a 38-year-old male received the right type of chemotherapy for his type of lung cancer, ROS1 fusion adenocarcinoma. His latest CT scan showed radiographic evidence of tumor improvement from the metastases.
Kaiser Permanente of the Mid-Atlantic States opened its new lab in March with a goal to advance this area of precision medicine by offering a variety of biomarker tests to identify specific cancer mutations.
This isn’t just about diagnosing cancer, but making sure the patient is getting individualized treatment, said Bruce Wollman, MD. He is associate medical director for government relations, radiation oncology, pharmacy, genetics and pathology for the Mid-Atlantic Permanente Medical Group, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
If a patient has lung cancer with specific genotypes, “we can target the chemotherapy for that patient's particular cancer, making sure we're giving the patient the best medicine for their individual tumor,” said Dr. Wollman, a diagnostic radiologist. This also cuts waste and unneeded expense from a systems perspective.
Kaiser Permanente of the Mid-Atlantic States serves more than 800,000 members at 35 medical centers in Washington, D.C., Maryland and Virginia. There, 1,700 physicians of all specialties from the Mid-Atlantic Permanente Medical Group are responsible for the full continuum of medical care.
The molecular laboratory, in Rockville, Maryland, is one of the few labs in the Greater Washington D.C. Area that does this type of testing and the only one that serves a fully integrated health care delivery system.
Learn more with the AMA about how pharmacogenomics enables a precision approach to care.
The biolab uses next-generation sequencing technology to look for protein expressions that provide information about patient-specific cancers. The next-gen sequencing biomarker test is available to all covered patients, “whether they're in a far-flung little clinic or one of our major medical centers,” said Dr. Wollman.
Starting with lung cancer, the lab has since expanded to breast and gastrointestinal cancer, with plans to launch melanoma sometime soon, said Ginine Beyer, MD, medical director of Mid-Atlantic’s pathology and laboratory medicine department.
“At a very high level, there are solid cancer types, which are the carcinomas, the sarcomas. And then there’s blood cancers, like lymphoma and myeloid malignancies,” said Dr. Beyer. The lab will have the capacity to test for both solid and hematologic tumors.
Lung-cancer screening is one of Kaiser Permanente Mid-Atlantic States’ most robust programs, screening five times more eligible patients than national averages, said Dr. Wollman. As a result, clinicians are finding a high number of early lung cancers. With the genetic testing, “we’re able to find the optimal targeted, treatment therapies for these lung cancers that we are finding earlier,” he added.
Thanks to the robust screening program, in 2017 Kaiser Permanente Mid-Atlantic States’ lung-cancer mortality rates were less than half the national average for both Black and white patients, and they anticipate survival rates to improve further with the personalized medicine approach.
“We know that the right therapy that's proven to be a target from the molecular genetic makeup of the tumor, will impact disease state,” she added.
Screening is always the first step of this process.
A mammogram of an asymptomatic woman for example, may yield suspicious findings on the imaging. A tissue biopsy is sent to Dr. Beyer’s pathology department. If cancer is identified and, if National Comprehensive Cancer Network-guideline appropriate, the specimen is walked down the hall for genomic testing via the next-gen sequencing assay.
“Our medical teams do a great job of procuring the appropriate amount of lesional tissues at biopsy, with intention to run the assay,” said Dr. Beyer.
Multidisciplinary conferences at Kaiser Permanente engage a breadth of physician disciplines to plan for the patient’s integrative cancer care.
Once a patient has an established diagnosis of cancer on a biopsy, “all of the departments and specialists involved discuss what your care is going to be,” Dr. Beyer continued. Patients meet with an oncologist, a surgeon and radiation oncologist. Even medical geneticists, as well as Mid-Atlantic’s clinical trials team, are informed of a patient’s disease type and category and weigh in on opportunities for care, including clinical trials.
Liquid biopsy is another forthcoming technology, which looks for minimal residual disease post treatment, said Dr. Beyer. “We will continue to press forward and provide our patients the most expert testing that we can.”