At Dana-Farber/Brigham and Women’s Hospital Center for Gastrointestinal Oncology, we view every patient as an individual, with unique needs and expectations. This understanding guides us in creating a treatment plan that takes your lifestyle and goals into account. As a new patient, you’ll have your tumors tested for molecular alterations, the results of which will help form the basis of your therapy. This testing falls into two areas:
- Specific clinical tests are routinely performed and automatically given to appropriate patients as part of our “standard of care,” which specifies appropriate treatment based on scientific evidence and collaboration between medical and/or psychological professionals involved in the treatment of a given condition
- Other tests that are not yet standard, typically fall into the category of research and are only performed on patient tumor samples following a discussion with the patient and acquisition of informed consent
Routine clinical genomic and molecular testing
The following genomic and molecular tests are performed as routine standard of care:
- Colorectal Cancer: Patients with stage 4 colorectal cancer are routinely tested for mutations in genes of the RAS family. Mutations in these genes are tested in DNA obtained from tumor cells (from the biopsy or surgical sample that was obtained to diagnose the patient’s cancer). This testing is routinely performed because the presence or absence of specific RAS mutations impacts decisions regarding the use of specific antibodies drugs that target a protein called EGFR (Epidermal Growth Factor Receptor).
- Gastric and Esophageal Adenocarcinoma: Patients with these cancers have their tumors routinely tested for overexpression of a gene called HER2 or ERBB2. Results from this testing impact decisions regarding the use of drugs targeting HER2 as part of therapy.
Research Testing
Research tests are administered differently than those tests that are part of routine care. While the routine tests are automatically performed on patient tumor samples, testing that is part of research is performed only following the specific informed consent of the patient.
The primary research test offered to patients treated within our center uses an advanced sequencing platform called OncoPanel that can detect not only genetic mutations, but also other critical types of cancer-related DNA alterations. With a patient’s consent, we acquire and test a sample of their tumor (which has already been obtained as part of clinical care).
DNA from the tumor is subjected to a comprehensive analysis to identify mutations in several hundred critical cancer-associated genes. Although this test is part of a research program, results from testing are available to the treating physician. These results may be useful in making decisions regarding possible clinical trials to consider. As we gain more experience with this testing, we hope to increasingly use such molecular profiling to identify optimal targeted therapies to test in individual patients.
In addition to OncoPanel, there are a number of specific clinical trials offered within our program where enrollment on the trial requires specific testing on the tumor. If your treatment team thinks that you may be a good candidate for a trial that requires such testing, your team may discuss pursuing testing of your tumor for the appropriate marker. As this testing is part of research, it would not be performed without your consent.
