In attacking the most dangerous and advanced forms of cancer, oncologists are using genetics to offer patients hope.
Next generation sequencing is a process of looking at cancer at the molecular level and searching for mutations that could be exploited using experimental drugs.
But while the treatment has been successful for some patients, research by a team of Community Health Network doctors shows that it should be used used carefully and in certain situations.
“We have this technology out there, but it has to be used judiciously. You have to be careful about the expense it entails to the health care system, but also be careful about the real human cost that comes from false hope,” said Dr. Sumeet Bhatia, an oncologist and hematologist at Community Health.
In June, a team from Community Health Network presented its findings to the annual conference of the American Society of Clinical Oncology, an organization dedicated to cancer research and improved patient care.
Their participation in the conference was unique. While prestigious academic institutions, such as Harvard University and Johns Hopkins University, do the majority of medical research, it is rare for a community-based health system to do this type of investigation, said Dr. Dale Theobald, medical director of the office of research administration for Community Health Network.
“That’s changed some over the years. Back maybe 20 years, most of the research happened in research institutions and universities,” he said. “But I think there’s a realization now that the real population that needs to be studied at some level occurs in the general public, and we have access to those patients that maybe a Johns Hopkins doesn’t have.”
The investigation into the effectiveness of next generation sequencing grew out of a desire to hone the tools Community Health Network physicians use to treat incurable cancers, Bhatia said.
They have used next generation sequencing for the past five years for patients with advanced, incurable cancer. The process breaks down the elements of a tumor at the molecular level. The genetic technology has developed to the point where medical personnel can get the entire genetic profile of a tumor, Bhatia said.
Working with a company in Cambridge, Massachusetts, physicians can determine if there are any active mutations that are making the cancer grow.
Those mutations could make the cancer susceptible to new treatments, said Dr. Pablo Bedano, an oncologist at Community Cancer Center South and member of the research team. A board of Community Health clinicians consults with pharmacists and molecular biologists to determine what treatments might work against the cancer.
The question became: how useful is it?
The tests could reveal useful results that physicians can seize upon to find a targeted treatment. But among those positive signals is also a fair amount of what Bhatia calls “noise” — results and mutations that are inconsequential to making a patient healthier.
“The challenge is distinguishing the signal from the noise. How can we help patients where we make a meaningful difference in their quality of life and survival?” he said. “Unfortunately the noise generated in these tests result in expensive and unnecessary interventions, which tend to detract from the quality, because we put them through treatments that are not helpful.”
Community researchers went back and looked at all of the cases where next generation sequencing had been used over 2015 and 2016. In reviewing the 209 individual cases, they tried to figure out if the findings would help them immediately, later or if they’d be no help.
In 10 percent of the cases, it helped treat patients right away, Bedano said. The results from another 16 percent showed mutations that could be exploited later in their treatment plan.
The study also revealed that the benefit was more effective in some forms of the disease, such as lung cancer, than in others, such as pancreatic cancer.
“The million-dollar question that comes up is, do you have the gene profile and can you actually use it to benefit patients. And the answer is not an unequivocal ‘yes,'” Bhatia said. “Definitely it is helping patients because there are certain patients where we are finding mutations for which it makes a difference. But at the same time, for every signal, there’s a fair amount of noise.”
The work on next generation sequencing is just one area of research that Community Health Network has embarked on. The network’s research department is only a few years old, but already has made strides in areas such as oncology, cardiology and orthopedics.
The hospital is active in cooperative group trials funded by the National Cancer Institute, working with researchers from throughout the country to gather data on new treatments for different cancers.
In the past year, it has also participated in trials through MD Anderson Cancer Network. The network allows hospitals and health care providers to collaborate with the Texas-based MD Anderson group, Theobald said.
“Trials that are going on at MD Anderson we can open up locally here, so our patients can have access to procedures and medications that would not otherwise be available to them,” he said.
Community Health Network researchers have also done extensive work investigating cardiovascular treatments. Patients in Johnson County can enroll in trials for new devices and medications to alleviate heart conditions.
Research is also being done in areas such as knee injuries and behavior health in adolescents, Theobald said.
“One of our core values is ‘Patients first.’ By doing research, we’re allowing patients to have access to procedures, processes and medications that they might not otherwise get,” he said. “It’s also wonderful for our physicians to be involved in research to grow in what they do.”
Having their research included by the American Society of Clinical Oncology was an honor, Bhatia said. But the motivation of their work was not to impress the academic world, but to improve the treatments for people with cancer.
“The focus is really what does this mean to a patient day-to-day,” Bhatia said. “I think we’re increasingly becoming more involved in health care and research as it relates to a patient, rather than the direct goal of academic glory.”