It’s a research initiative of the B.C Cancer Foundation that, according to its clinical lead, Dr. Janessa Laskin, promises to fundamentally change the way cancer is diagnosed and treated.
The program, called Personalized Onco-Genomics — or simply POG — is based on the fact that cancer is a complex disease with an enormous variability in behaviour and response. Researchers have known for some time that the same types of cancer — sometimes even in varying locations in the same patient — will respond differently to therapy. Cancer may even evolve in response to treatment.
Researchers have now determined that one cause of this variability is that every cancer has a unique molecular signature.
That’s where POG comes in. Patients within the study are subjected to in-depth DNA and RNA sequencing that in turn is used to identify mutations, gene ‘expression changes’ or other abnormalities that might be driving the cancer in question.
The approach promises to be a game changer, and thanks to Laskin and Dr. Marco Marra, the genome lead on the project, it has placed B.C. in the forefront of this field of research and treatment.
“We’re way ahead of the curve. This just doesn’t exist anywhere else in the world,” said Laskin.
The program started in 2008 when a colleague, Dr. Donald Rix, who had been diagnosed with cancer, sought treatment from Laskin for his ‘very unusual’ type of the disease.
“We didn’t really know which of the drugs we had would work and he suggested that we consider gene sequencing of the tumor to help narrow down treatment,” said Laskin.
This was all happening at a time when the technology for gene sequencing had advanced to a point where the concept was becoming viable.
Based on the initial success of that approach, and continued advances in both performing gene sequencing and understanding its results, the POG program was launched in 2014.
Since then, the program has admitted 485 patients. And there have been some successes.
Take Trish for example.
Her case study is recounted by the B.C. Cancer Foundation on their website and tells the story of a vibrant mother of a 27-year-old son whose aggressive colorectal cancer had resisted chemotherapy, several surgeries and radiation therapy. Facing a terminal diagnosis, she was enrolled in the study where genetic sequencing of the cancer identified a protein up-regulation that appeared to be driving her particular disease. A drug, generally prescribed to control blood pressure, was administered and within weeks the cancer had abated.
According to Laskin, there have been other similar success stories.
“These are still pretty much ‘one-off’ cases, but they all serve to open new areas of research and treatment,” said Laskin.
As to why this study is unique to B.C., Laskin acknowledges that other cancer centres around the world are now trying to get up to speed on the approach.
But it’s an approach that isn’t easily emulated.
“We’re lucky to have the Michael Smith Genome Sciences Centre right here in Vancouver,” said Laskin. “It’s one of the top three facilities of it’s kind in the world.”
The scientists involved in the project are called ‘bio-informationalists’ and they specialize in interpreting the gene sequencing information that is at the heart of the project. Under the leadership of Marra, these skilled individuals make sense of the data generated by the sequencing project.
Laskin explained the process is a combination of biology and mathematics. She said the amount of data is “mind-boggling.”
“The real challenge is to have the scientists who understand these masses of data and can tease out the relevant information to allow us to translate that into treatment programs.”
But the program is not without its challenges.
Funding is always difficult. The POG program has been funded almost entirely through the B.C. Cancer Foundation, which relies significantly on public and corporate donations. That funding has been augmented by grants.
Another problem is access to drugs that would help patients but are not available due to regulatory restrictions. Drugs are licensed for use for specific ailments and the ‘off-label’ use of those drugs for other purposes is often restricted.
But Laskin is optimistic.
“We just have to collect the data and recognize that we’re at the beginning of a new era of oncology. We’re on a steep learning curve in which we’re really having to educate the establishment, both here in B.C. and around the world,” she said.