On Thursday the health system announced it would be the first in the country to offer whole-genome sequencing at the clinic level – making more widely available a technique that in the past has been reserved for researchers and the very rich.
Patrick Soon-Shiong, a high-profile doctor and entreprenueur who has made whole-genome mapping a priority, will partner with Providence to conduct analysis of the results from 10 of the latest-model sequencing devices. Providence treats more than 20,000 new cancer patients per year in California, Washington, Montana, Alaska and in Oregon.
“The immediate and individual benefit for patients is we find out what mutations are present in your tumor,” said Dr. Walter Urba, research director at the Robert W. Franz Cancer Research Center at Providence Cancer Center in Portland.
The announcement caught scientists at Oregon Health & Science University off guard.
With a flourishing cancer genomics research program, the university is on the way to raising $1 billion toward making its Knight Cancer Institute one of the top cancer research centers in the country.
But OHSU has not purchased the new machines — they cost $1 million a piece and are sold in lots of 10 — and didn’t know Providence had them, said Dr. Chris Corless. He oversees OHSU’s consumer-level sequencing, which focuses on a smaller slice of the most likely tumor mutations.
“It’s a bit of a surprise to me,” he said of the Providence announcement.
Over the last decade, researchers have found that the old way of thinking about cancer — based on the location of a tumor — was way off base. For example, the genetic makeup of a tumor in the lung may have far more in common with skin cancer than other lung tumors. The one-size-fits-all treatment of a particular tumor based on where it was found went hand-in-hand with treatments like chemotherapy– which killed healthy cells as well as tumor cells, like a medical version of napalm.
The new genetically targeted drugs based on DNA mapping are more like a guided missile. They rely on advances in DNA sequencing that accurately classify tumors to select the best treatment. They are not available for all cancers, and can cost $100,000 or more per year, but these drugs halt and reverse a tumor’s growth without major side effects. One of the first such drugs was Gleevec, which has saved the lives of countless people with chronic myeloid leukemia.
However, doctors helping cancer patients have, for the most part, not been able to use whole-genome sequencing, the most in-depth and thorough method of mapping a tumor. It’s been too costly to analyze the immense amount of information produced by the procedure.
Now, in addition to using the late-model machines, made by Calilfornia-based Illumina — purported to bring costs down to $1,000 per person — Providence Health will use supercomputers programmed by Soon-Shiong’s company, Nanthealth, to analyze the results.
California-based Nanthealth claims a rapid turnaround that in theory could someday lead to same-day processing and analysis of the results.
Over at OHSU, Corless says the university is moving toward offering whole-genome sequencing to consumers next year using supercomputers provided by Intel.
But he cautioned that the more limited tests used and marketed by OHSU and Providence already capture the most common types of tumors, allowing rapid diagnosis and treatment.
Because the lesser-known mutations targeted with whole genome sequencing are still being classified, the full DNA map of tumors is not as useful now as it someday could be, Corless said.
“I have to say I admire the fact that Providence and Dr. Soon-Shiong are willing to make this investment,” he said. “I think it’s courageous. But I also would be a little bit concerned about how they are going to manage the sheer amount of information that is going to come down.”
Urba said the previous level of genetic sequencing used by Providence and OHSU, looked at a few dozen “pathways,” or known locations in the gene where the most common cancer mutations are found. He said that technique remains very useful, but looking at tumors’ entire DNA will eventually lead to better treatment.
“There are clearly mutations that occur outside of those pathways that are potentially important,” he said.
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.