Special Issue of Acta Medica Academica (AMA) focused on Genomics in Hematology and Oncology Practice
A special issue of Acta Medica Academica (AMA) focused on Genomics in Hematology and Oncology Practice was recently edited by Dr. Gordan Srkalovic (Medical Director, Herbert-Herman Cancer Center, Sparrow Health System, Lansing, Michigan, USA). As a guest editor, he brought together a network of leading oncologists in the field to write on Precision Medicine in their areas of expertise. Sparrow Cancer Center is a 1stOncology Healthcare Partner and in this blog article we cover this timely resource that describes the possible boons of Genomics in Cancer Therapy. This full treasure trove of a special issue of Acta Medica Academica is available totally free at the link below so read, enjoy, and push the boundaries of science to find more therapies for cancer throughout the world!      

The year of 1999 witnessed a revolution in science, because the United States National Institutes of Health (NIH), along with other institutions of the world, revealed the secret ‘blue-print’ of the genetic code of human species – the human genome. Dr. Francis Collins (Director, NIH) proudly proclaimed in his publication that this would change the that way we think of medicine, and would create new ways to diagnose, prevent, and treat diseases (1). This vision became the template for change. The years kept on flowing, but the progress in Precision Medicine did not occur as predicted, not until more than 15 years later.

Then, in 2016, then-Vice President Joe Biden started a movement out of his own personal tragedy called “The Cancer Moonshot Initiative”. This was meant to accelerate cancer research that was aimed to make various therapies available to more patients, while also improving physicians’ abilities to prevent cancer and detect it at an early age. This fell into the 21st Century Cures Act and was signed into law by President Obama. It opened up the silos between the laboratories, industries, and computer experts, and exploded the field of cancer genomics.

For clarification: Genomics is NOT the same as Genetics! In cancer genomics, the genome of the tumor (not of the person) is carefully studied, and the abnormalities in the cancer genome that cause the development and growth of cancer is analyzed to find improved methods for diagnosing and treating the disease. This tsunami of information has led to fast development of therapies and approvals of targeted therapies that are saving lives with lesser side effects. Lung cancer is a classic example of this. It is hard for us to keep track of all this information. This is where we need a reference, updated, and reliable book – a manual that summarizes the key information for each type of cancer and that can educate the readers on different types of cancer treatments in this new age.

A special issue of Acta Medica Academica (AMA) focused on Genomics in Hematology and Oncology Practice was recently edited by Dr. Gordan Srkalovic (Medical Director, Herbert-Herman Cancer Center, Sparrow Health System, Lansing, Michigan, USA). This blog article seeks to cover this timely resource that describes the possible boons of Genomics in Cancer Therapy. As a guest editor, he brought together a network of leading oncologists in the field to write on Precision Medicine in their areas of expertise. Thus, we have a confluence of knowledge available here, all for free, just for your benefit, dear readers. So read, enjoy, and push the boundaries of science to find more therapies for cancer throughout the world. Here, we have summarized below what you will find inside this treasure trove.

The journal opens with an article by Trivedi et al (2019) that looks at the use of genomics and the changing landscape of clinical practice in the modern medicine (2). The style of medical treatment has changed much over the years and there has been a massive influx of new technologies. The next step is to personalize disease management. However, there are challenges to fully make the jump from genomics to personalized treatments. Here they discuss some of these challenges and evaluate potential solutions.

This is followed by an article by Audeh et al (2019) which explains the 70 gene MammaPrint assay that was developed as the genomic assay for diagnosis of breast cancer. This test was validated with a randomized trial. It is the first US FDA cleared genomic test for breast cancer (3). The authors describe how this assay was created, and what information it can provide to women so that not everyone needs to go through chemotherapy.

Next, Madanat et al (2019) describe the recent advances in the genomics of acute myeloid leukemia (AML) and present the current state of the field (4). Authors summarized an up to date review of all the published data about genes that are commonly mutated, and the genomic pathways involved in AML. The review highlighted the use of genomics to combat AML’s future gene mutations and their interactions. Therefore, this data is important for the future therapeutic directions in the field of AML.

An article by Shi et al (2019) follows this, where the authors aim to summarize recent developments in laboratory work-up on lymphomas and discuss their clinical relevance (5). The paper goes in depth about these developments, but for our purposes, the main importance are ideas regarding research and clinical care of patients. Although there are newer and cheaper ways to test genetic abnormalities some of those are time-consuming and do not provide needed information. Not only that these options are still relatively limited, but also, widespread knowledge about advanced genetic testing is scarce, even among clinicians. Thus, they note the need for lot of basic groundwork before dwelling deeper into the field and trying to utilize it in this context.

We then move on to Castaneda et al (2019) who provide a concise review on the genetics of multiple myeloma (6). The authors describe how the multiple myeloma disease is considered incurable at present and they review the heterogeneity in its clinical presentation that can be traced to cytogenetic abnormalities in the malignant clone. They focus on emerging cytogenetics of multiple myeloma and discuss how the field of genomics in multiple myeloma has grown, as well as the current issues faced by the field. They concluded that personalized medicine is an ongoing challenge for myeloma patients because of the complexity and heterogeneity of the disease. However, they offer hope that as a result of ongoing genomic “revolution”, we could expect development of improved therapies.

Devitt et al (2019) review the current role of genomic testing in the risk, prognosis, and treatment of genitourinary malignancies (7). The authors describe how genitourinary cancers (their focus was prostate, kidney, and urothelial cancers) have not yet experienced the benefits of genomic data as much as other cancers, but the data is helpful in identifying those patients who have a high risk of getting the cancers. They also say that more therapeutic opportunities will be available for these patients in the future.

Next is an article on Lung Cancer Genomics by Parikh (2019) (8). Advanced lung cancers tend to have poor prognoses due to limited treatment options. However, with the use of genomic testing, the landscape of other treatment options is improving all of which can help these patients live longer.

A review article on Genomic-Based Therapy of Gynecologic Malignancies by Markman (2019) looks to inform about the recent advancements made in the use of targeted therapeutics in management (9). Testing of genomic abnormalities has been limited mostly to two genes in these types of cancers. However, with recent advances in precision medicine, the author anticipates that more tests and more options may become available for diagnosis and therapy of gynecological cancers.

Saadeh et al (2019) reviewed the role of precision medicine in oncologic pharmacy practice. This is unique because it talks about pharmacogenomics (PGX) (10). This concept of PGX is part of the precision medicine approach. It studies how genetic variations may influence an individual’s response to drug therapy. It is based on inherited polymorphisms in drug metabolizing enzymes or other targets. Recommendations from PGX can help prevent newer and existing drug toxicities that are common in cancer patients under treatment.

Lastly, Trivedi et. al (2019) describes the experience and outcomes from 54 cases presented to the Molecular Tumor Board (MTB) established at the Herbert-Herman Cancer Center, Sparrow Health Systems (Lansing, Michigan, USA) between 2017 and 2018. During this time, all patients under treatment considerations had different types of cancers. These cases were presented virtually by oncologists and discussed with the scientific and clinical team of Foundation Medicine company. The goal was to identify specific molecular pathways to precisely determine treatment target options or trials for each cancer patient. These patients badly needed other and newer options because their tissue analyses had not shown targetable mutations. Of these patients, 81% had one or more potentially actionable alteration and 22% received genomic-matched therapy as per MTB recommendations. The multidisciplinary approach of MTB combined with new technologies allowed for improved oncology patient care. Therefore, it was concluded that such usage and education about MTB should increase in other community centers as well, so that advances of precision medicine are brought to as many patients as possible. This is a highly novel and innovative approach because it dissolves the boundaries of different disciplines while keeping the patient’s interest at the center.

What comes next in the field? The ultimate goal of precision medicine is to become the method of choice to use for all types of patients, not just cancer patients. By developing a computer skillset that can organize massive amounts of patient data and create algorithms, we can anticipate and prevent disease in patients in any and every field of medicine beyond cancer medicine. This is exactly what the “ALL OF US” movement is doing. So, dear readers, please join in and learn, as the time is ticking away. Get on board. Otherwise, as Dr. Srkalovic says “you will be dinosaurs” and generations may watch you in the Jurassic Park series.

References
1. Collins, Francis S., et al. “A New Initiative on Precision Medicine: NEJM.” New England Journal of Medicine, 17 Mar. 2020.
2. Trivedi H, Kling HM, Treece T, Audeh W, Srkalovic G. Changing Landscape of Clinical-Genomic Oncology Practice. Acta Med Acad. 2019;48(1):6-17.
3. Audeh W, Blumencranz L, Kling HM, Trivedi H, Srkalovic G. Prospective Validation of a Genomic Assay in Breast Cancer: The 70-gene Mamma-Print Assay and the MINDACT Trial. Acta Med Acad. 2019;48(1):18-34.
4. Madanat YF, Kalaycio, ME, Nazha A. Advances in Acute Myeloid Leukemia Genomics, Where Do We Stand in 2018? Acta Med Acad. 2019;48(1):35-44.
5. Shi M, Dao L, Jevremovic D. Laboratory Work-Up of Chronic B-Cell Lymphoid Malignancies– A Value-Based Approach. Acta Med Acad. 2019;48(1):45-56.
6. Castaneda O, Baz R. Multiple Myeloma Genomics – A Concise Review. Acta Med Acad. 2019;48(1):57-67.
7. Devitt ME, Dreicer R. Evolving Role of Genomics in Genitourinary Neoplasms. Acta Med Acad. 2019;48(1):68-77.
8. Parikh AR. Lung Cancer Genomics. Acta Med Acad. 2019;48(1):78-83.
9. Markman M. Genomic-Based Therapy of Gynecologic Malignancies. Acta Med Acad. 2019;48(1):84-9
10. Saadeh C, Bright D, Rustem D. Precision Medicine in Oncology Pharmacy Practice. Acta Med Acad. 2019;48(1):90-104.
11. Trivedi H, Acharya D, Chamarthy U, Hamdan M, Herman J, Srkalovic G, et al. Implementation and Outcomes of a Molecular Tumor Board at Herbert-Herman Cancer Center, Sparrow Hospital. Acta Med Acad. 2019;48(1):105-15.

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