City of Hope is committed to providing world-class, patient-focused cancer care. Our comprehensive cancer center recently received an “exceptional” rating by the National Cancer Institute (NCI) — the highest rating possible for a U.S. cancer center — putting the center in the top echelon of the nation’s 53 NCI-designated comprehensive cancer centers. But our work doesn’t stop there. We are continuously working to translate leading-edge precision medicine advances into tailored treatments and improved preventive care strategies for the broadest patient population.
A comprehensive genetic testing program
City of Hope's Center for Precision Medicine is undertaking a major initiative to broaden patients' access to comprehensive genetic testing. Under the INSPIRE (Implementing Next-generation Sequencing for Precision Intervention and Risk Evaluation) study, City of Hope makes comprehensive genetic testing available to every person seen for care — regardless of the diagnosis.
A person who elects to participate is offered the option to undergo germline genetic tests for 189 genes related to risk of cancer and other medically actionable disease-causing variants. Genetic tests for inherited susceptibility have been shown to save lives for patients and their family members, and City of Hope's panel of cancer genes is the most comprehensive test for cancer susceptibility. In addition, City of Hope's panel includes important genes for general health, such as familial hypercholesterolemia, heart disease and sensitivity to certain drugs.
“Individuals who test positive for a germline gene change are referred to see us,” says
Heather Hampel, M.S., CGC, clinical professor, Department of Medical Oncology & Therapeutics Research and associate director, Center for Precision Medicine. “That way we streamline the process and ensure the individuals who need it most receive genetic counseling. City of Hope has one of the largest cancer genetic counseling teams in the United States, and we are focused on treating the whole family since these gene changes are heritable.”
In addition to the germline testing, patients with cancer and suitable tumor samples may receive ultracomprehensive, whole-exome and whole-transcriptome tumor sequencing
with a "best in class" test that looks for somatic mutations. This test, called OncoExTra, was developed at City of Hope's Translational Genomics Research Institute. Because it includes RNA analysis, it can detect gene fusions that arise from faulty breakpoints in the DNA sequence that can be missed with DNA sequencing alone.
All the molecular information obtained from a given person is securely combined and undergoes systematic review. All individual germline genetic test results are reviewed by a genetic counselor. Tumor testing is reviewed by the patient's treating oncologist. Complex cases are referred to the Precision Oncology Tumor Board for multidisciplinary review by leading experts in the interpretation and application of genomic data. The board submits its conclusions into the patient's electronic medical record, along with the curation and annotation that doctors need to optimize treatment.
The INSPIRE precision medicine study is an addition to City of Hope's longstanding general research study (biorepository). INSPIRE will eventually be offered to patients throughout City of Hope's growing national system, which includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix.
This precision medicine initiative is far more than a gesture of generosity. It is an attempt to prove beyond doubt that genetic testing can save lives. Through this initiative, City of Hope seeks to help close the gap between the current era of rapid innovation in oncology and the delivery of the benefits of that innovation to a broad population. City of Hope is committed to serving the needs of the community and ensuring that every person living with cancer has access to leading-edge, optimal cancer care.
"We believe comprehensive molecular profiling is the future standard of care in oncology,' says Stacy W. Gray, M.D., chief of the Division of Clinical Cancer Genomics and deputy director of the Center for Precision Medicine. "We want to bring it as quickly as we can to as many patients as possible."
“Our goal is to collect enough data to demonstrate the value of testing for all,” says Gray. “If we identify a mutation known to be associated with elevated cancer risk, it could mean increased screenings to catch cancer at its earliest, most treatable stages, risk-reducing surgery and/or new medications.”
More than 15,000 patients have received genetic testing in less than three years
INSPIRE has enrolled more than 15,000 people to date and the number is growing. Approximately 20% of patients who have undergone germline testing in INSPIRE have tested positive for a disease-causing gene variant. The genetic data obtained have proved extremely valuable for guiding individualized preventive care and treatment strategies.
City of Hope's approach flips a standard paradigm in cancer genetics. Rather than spending time with anticipatory guidance about hypothetical results for each patient prior to testing, City of Hope obtains up front informed consent and then concentrates on providing meaningful information after test results are available. Patients are referred for genetic counseling after they test positive for a heritable mutation.
While the organization's approach to genetic counseling is to deploy it smartly and selectively, its wider mission is to extend access to precision oncology to the broadest possible population — regardless of race, socioeconomic status, insurance provider or geography. City of Hope's efforts are helping to correct longstanding disparities in access to cancer genetic information. According to Stephen Gruber, M.D., Ph.D, M.P.H., vice president of City of Hope National Medical Center and the Eva and Ming Hsieh Family Director's Chair of the Center of Precision Medicine, the aim should be to move away from waiting to find out if a patient qualifies for molecular testing.
"Those criteria are established in part by insurers to determine whether testing should be reimbursed," says Gruber. "Those guidelines are complex and evolving. In our view, if you are a cancer patient, molecular testing is indicated." After all, the wider the net is cast on testing, the greater the chances of a success where potentially lifesaving preventive measures and precision treatments can be extended not only to cancer patients and survivors, but their families, too.”
"This type of initiative takes a huge investment on our part. We believe it's the right thing to do for our patients because it has a major impact on improved outcomes,” says Gruber. "We've been ahead of the curve, but the ground is shifting, and increasingly these types of tests are being covered by insurers.”
About City of Hope's Center for Precision Medicine
The vision of City of Hope's Center for Precision Medicine is to harness genomic insights, clinical expertise and advanced analytics to pioneer personalized treatment and prevention, improving quality of life for patients and their families. The multidisciplinary collaboration that drives the Center for Precision Medicine includes experts in medical oncology, genetics, genetic counseling, epidemiology, gastroenterology, surgery and other specialty services. These experts are dedicated to advancing the state-of-the-art in precision oncology and translating the latest knowledge into protocols that improve treatment and prevention. This evidence-based approach leads to discoveries with real clinical relevance.
Refer a patient
To refer a patient, please call 877-354-4188 or visit CityofHope.org/patients/refer-a-patient.
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