Rob Leighton’s colon cancer had persisted through a barrage of treatments when his doctor suggested a new test.
The Westbrook man had already undergone the standard treatments following his diagnosis in March 2016: surgery, radiation, chemotherapy and even immunotherapy, a newer generation of treatment that boosts the immune system’s ability to fight cancer cells.
Still, the tumors continued to grow, and had spread from Leighton’s colon to his liver and lungs.
“I was pretty much running out of options,” Leighton said.
His oncologist asked if he wanted to try another approach. Rather than treating his type of cancer, they could try to treat his individual cancer.
As with any other patient with that form of the disease, the dangerous cells metastasizing in his body had originated in his colon. But the DNA within those cells had mutated in ways particular to Leighton, ways that might make his cancer susceptible to special drugs. If Leighton and his physician could pinpoint the unique combination of genetic mutations in his tumors, a type of molecular signature, they could then attempt to exploit them to kill his cancer cells.
They took a tiny sample of his cancerous tissue from a previous procedure and sent it off to be analyzed. And with that, Leighton began participating in a statewide initiative to expand access to the testing, known as genomic testing or molecular profiling.
The Maine Cancer Genomics Initiative, spearheaded two years ago by The Jackson Laboratory and supported by a more than $8 million donation from the Harold Alfond Foundation, has now enrolled more than 300 patients from hospitals and private practices across the state. Beyond the testing, the initiative links patients with clinical trials and other personalized treatment options. It’s also building a network of cancer clinicians throughout Maine and giving them access to the latest in cancer research.
Ultimately, the ambitious initiative aims to help change how cancer is diagnosed and treated in Maine, deploying Jackson Lab’s research to even rural areas of the state with hopes of bringing patients the most promising treatments. The initiative carries high stakes in Maine, where an estimated 8,600 new cases of cancer are expected to be diagnosed in 2018 and where cancer is the number one cause of death among adults, claiming lives at a higher rate than most other states.
It’s too early to say whether the effort has saved lives, and skeptics of this type of “precision medicine” argue that its limited successes have been overblown. But the initiative is bringing a new frontier in cancer treatment to corners of Maine that might have waited years for it otherwise, and at virtually no cost to patients.
‘It just gives us other options’
For decades, treatment of cancer has followed at least one of several routes: Cut it out with surgery, zap it with radiation, or blast the body with chemotherapy drugs to kill the cancer while hoping healthy cells recover. Newer approaches include immunotherapy, but for many patients these three treatments have represented the standard of care.
Now, clinicians can mine each patient’s genetic profile for information to help customize their treatment. Patients enrolled in the Maine Cancer Genomics Initiative are tested for more than 150 cancer-related genes that Jackson Lab has identified as “clinically actionable,” or those that doctors can potentially do something about. Any mutations that turn up in the test are run through the lab’s database, which spits out information about potential therapies or clinical trials matching that particular mutation. The results are then returned to the oncologist in a report two to three weeks later.
“This is basically a way to understand better what the patient’s individual cancer consists of,” said Christopher Darus, director of research in gynecologic oncology at Maine Medical Center.
Think of it this way, he said: The world’s most complex machine is broken, and you need to fix it. To do that, you must know its inner workings.
“The cancer cell is way more complex than any machine we have,” said Darus, a member of the Maine Cancer Genomic Initiative’s steering committee.
“What we’re looking to do is to exploit changes on the cancer cell to help kill it,” he added. “Every single cancer is different in every patient.”
Darus’ practice, along with another gynecologic oncology group at Biddeford’s Southern Maine Medical Center and a neuro-oncologist at Maine Medical Center, has enrolled 95 patients in the initiative, the most of any single site.
The program is open to any patient with solid tumors, such as lung, breast and prostate cancer, but excluding those with leukemia. Many patients enrolled in the program have already tried the standard treatments, such as chemo and radiation, and are no longer responding or can’t tolerate the effects, Darus said.
“It doesn’t change or take away our standard treatments. It just gives us other options,” he said.
The testing, which can cost from $2,000 to $5,000 per test, is covered by the Alfond grant. By participating, patients agree to be part of a research study, providing feedback about their experience though surveys. Their oncologists are part of the study, too, filling out questionnaires about how the testing affects their decision-making in treating patients.
Nearly 90 percent of the roughly 60 oncologists practicing in Maine have enrolled as study subjects themselves, with at least half also having patients enrolled, said Jens Rueter, medical director of the Maine Cancer Genomics Initiative. The clinicians represent every health system in the state and nearly every oncology practice, he said, forming a collaborative network that also benefits from regular communication with leaders in oncology research. Doctors in rural Maine can consult remotely with experts — from hospitals including Dana-Farber Cancer Institute in Boston and MD Anderson in Texas — about their patients’ medical conditions and treatment options.