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Oncology Innovation in Nashville


 

City's Key Players Lead Promising Research, Treatment Efforts

Sarah Cannon Investigates NGS-Based Molecular Profiling

Researchers at Sarah Cannon are using DNA sequencing technology to identify the most effective, personalized treatment for each tumor.

At June's American Society of Clinical Oncology (ASCO) annual meeting, Sarah Cannon researchers presented results of a six-year analysis that evaluated adoption and utilization of NGS-based technologies in community practices. Andrew McKenzie, PhD, Manager of Personalized Medicine at Sarah Cannon, said initial hesitancy over precision medicine has been replaced by excitement, as approval of new drugs resulting from NGS research continue to show promise.


Andrew McKenzie, PhD

"As research has advanced, people have become excited to see wide adoption of NGS testing, especially when connected into clinical research to develop more personalized treatments for people facing cancer," McKenzie said. "NGS is especially helpful when matching patients to clinical trials. The proof is in the approvals we're seeing, and that doesn't have any sign of slowing down."

For Sarah Cannon researchers, that means more hope for patients in community-based, rural practices, which didn't have access to NGS testing five years ago. That's due partially to innovators like Sarah Cannon, who are building infrastructure to support availability of testing to oncologists outside of large medical centers.

Sarah Cannon Research Institute studies also demonstrate the economic impact of NGS. "From both tissue exhaustion and economic standpoints, studies show it's a much more efficient process to do it all at once," McKenzie said, noting the potential loss of both time and health through repeated traditional biopsies.

As NGS testing becomes widely available, Sarah Cannon researchers also are cautioning against exclusive use of plasma-based testing, preferred by many oncologists for their convenience. "Samples from a blood draw are easier to obtain over a tissue sample, but you're limited with those tests by what it can detect," warned McKenzie. "Some providers are getting enticed by ease of use for plasma, where the gold standard is still tissue based NGS."

Those discrepancies are the subject of a paper currently in the works at Sarah Cannon Research Institute.


GI Innovation at VICC

Colorectal cancer research is getting a boost at Vanderbilt-Ingram Cancer Center, where researchers have received several million dollars in research grants from the National Cancer Institute. Funds include a Gastrointestinal SPORE grant for a five-year period totaling $11.6 million and an $11 million Cancer Moonshot grant.

In June, the department also made headlines by recruiting Cathy Eng, MD, to serve as the co-director of Gastrointestinal Oncology and co-leader of the GI Cancer Research Program. A national and international leader in colorectal cancer, appendiceal, and anal cancer research, Eng joined VICC after a 17-year career at MD Anderson Cancer Center, where she served as associate director of the Colorectal Center, chair of the Clinical Research Committee and chair of the Multidisciplinary Colorectal Cancer Tumor Board. Previously, she also served as chair of the National Cancer Institute Rectal/Anal Cancer Task Force, and co-chair of the Rectal/Anal Subcommittee for the Southwest Oncology Group (SWOG). She currently serves as vice-chair for the SWOG GI Committee, member of the ECOG-ACRIN Cancer Research Group GI committee and is a member of the NCI GI Steering Committee.

"Vanderbilt-Ingram Cancer Center has a longstanding reputation, but the main reason I chose to lead the GI program is because of the opportunity to help strategically develop and mentor an internationally-respected, multi-disciplinary group," Eng said.

In her new role, she is focused on expanding awareness of clinical trials targeting metastatic colorectal cancer, still the second leading cause of cancer deaths in the U.S. "If there's a patient seeking clinical trials, we have multiple options, including several for treatment-resistant and rare mutations, as well as for generalized cancer with no mutations," she said. Eng encourages providers and patients alike to consider trials earlier in their diagnosis, noting the rare use of placebo among the high-risk population.

She's also committed to increasing awareness and support of young adults with colorectal cancer and is building a program designed to meet their unique physical, educational and emotional needs. "People still think the average colorectal cancer patient is in their late 60s, but so many today are younger," said Eng, who is working to identify causes of colorectal cancer in a disturbingly younger population. "We have to find a way to recognize the diagnosis and support them earlier, because I constantly hear from this population that people just don't understand what they're going through."

Unlike older patients, which often have the benefit of stable family and financial lives, young adults often are dealing with relationship and fertility concerns, job security and lack of funds. They also have added concerns of body image, quality of life and sometimes colostomy. "The reality is this is one of the most preventable cancers, and we have to find a way to recognize and support these patients earlier," Eng said.


Imaging Advances at Saint Thomas

Saint Thomas Health is bringing innovative diagnostic technology to cancer patients in Middle Tennessee. The system recently unveiled Hologic 3D/Tomography units at their Midtown and West campuses, while the Hologic Affirm 3D Stereotactic Breast Biopsy System was added to Midtown. "We have many exciting technologies for optimizing care for our breast cancer patients," said Lisa Bellin, MD, Ascension Saint Thomas breast surgeon.

Hologic 3D/Tomography is approved by the FDA as a superior mammogram for women with dense breasts and detects 20-65 percent more invasive breast cancers compared to 2D mammography alone. Its SmartCurve™ system mirrors the shape of a woman's breast and is clinically proven to improve comfort in 93 percent of patients who reported moderate to severe discomfort with standard compression technology.

"3D breast tomosynthesis imaging is helping to screen our patients both more reliably and more efficiently," said Bellin. "Tomosynthesis mammograms help find more breast cancers since the technology is more sensitive and specific, resulting in fewer callbacks and less anxiety for patients."

The Hologic Affirm 3D Stereotactic Breast Biopsy System ensures surgeons can biopsy lesions found during screening with certainty, while providers also appreciate a large field of view, simple touch screen controls and clear displays of safety margins. Saint Thomas Health also added MagView Mammography Information System with High Risk Assessment Modeling, as well as SOZO bioimpedence spectroscopy (proactive lymphedema assessment) and its new OncoLens tumor board software.

"OncoLens is a secure, tumor-specific sharing platform where our multidisciplinary providers can directly share and collaborate inpatient care," Bellin explained. "The lymphedema impedance spectroscopy enables our lymphedema specialists to screen for increased fluid within our patient's arms when less than a tablespoon worth of extra fluid has accumulated. Traditional methods cannot detect this until up to one to two cups of fluid has accumulated." Bellin said this results in much more effective intervention and care for patients in improvement of the quality of life.

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Sarah Cannon

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Tags:
3D Mammography, Andrew McKenzie, Cathy Eng, Colorectal Cancer, DNA Sequencing Technology, GI Cancer Research, Hologic Affirm 3D Stereotactic Breast Biopsy System, Lisa Bellin, NGS-Based Molecular Profiling, OncoLens, Precision Medicine, Saint Thomas Health, Sarah Cannon, Vanderbilt-Ingram Cancer Center, VICC
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