By Allison Proffitt
June 12, 2015 | Foundation Medicine’s genomic tests have
been on the market since 2012—a lifetime in the field of genomics. The company’s
two tests—FoundationOne, a cancer genomics assay focusing on solid tumors, and
FoundationOne Heme, a DNA and RNA sequencing test looking for mutations common
in common in sarcomas and hematologic cancers—have populated FoundationCORE, a
database of genomic information.
At a time when talk of infrastructure to connect patients
and data is everywhere, Foundation Medicine already has genomic profiles fom
over 43,000 patients, all connected to their oncologists.
Foundation realized that some of the variants it was
reporting were extremely rare for institutions, explains Gaurav Singal, Director
in the Innovations Unit. In digging into the CORE data, FMI found that 61% of
the findings Foundation Medicine reports have never been seen at the ordering
institution. But if doctors knew where to go for help outside of their own
institution, things looked better: 91% of those novel mutations can be matched
within FoundationCORE, Singal says.
“Is there a way to use Foundation Medicine’s database,”
Singal asked, “to help match physicians wherever they are who are treating these
patients with rare genomic findings and help them learn from each other’s
experiences?”
The answer is PatientMatch, a module the company launched in
January within its Interactive Cancer Explorer (ICE) dashboard.
“Broadly speaking, the vision is this: the world of cancer
care is becoming so nuanced, and these finding are becoming so, so rare.
Patient populations are getting so small, that most physicians don’t know which
patients they should be comparing,” Singal says. “The concept of precision
medicine means that each patient is an individual, but that doesn’t mean that
there aren’t similarly unique patients.”
The user interface for PatientMatch is simple. A treating physician
views the results of a patient’s FoundationOne or FoundationOne Heme test in
the ICE dashboard. Within the FoundationOne results report, ICE lets the
physician know how many other FoundationCORE patients have similar mutations.
If the treating physician wants to get more information about
patient experiences, PatientMatch generates a simple email to those patients’
doctors identifying the mutation in question and asking four questions: In this
case, what drug was used? How long was the patient on it? Is the patient still
on the drug? What was the best response? From there, the two physicians can
connect and share further information if time and interest allow.
“This is the way medicine has to be practiced,” Singal says.
“We have to learn from each other’s experiences. We have to build that
community and it’s exciting to be able to bring that to life.”
PatientMatch, Trial Match
At Sarah Cannon Research Institute, in Nashville, Tenn.,
Todd Bauer, Associate Director of the drug development program has been using
Foundation Medicine’s tests for over a year, and has been beta testing PatientMatch
for six to nine months.
Bauer says that the Sarah Cannon oncologists have been very
happy to learn and implement a new system to connect their unique patients with
the right options.
“There are lots of oncologists still practicing for whom
when they completed training there was approximately five drugs to treat
cancer. The number and rate of new drugs coming out is just too much for anyone
to keep up with,” Bauer said.
He says the Sarah Cannon doctors have found reaching out to
other physicians with similar patients well worth it. “It might take them an
extra five minutes in clinic, but it’s a necessary five minutes. It’s not a
nice add-on; they need to be doing it for their patients, and the majority of
them are.”
Although it’s not Foundation Medicine’s primary application
of the PatientMatch tool, Sarah Cannon has had great success using the system
to connect patients to clinical trials, Bauer said.
“One of the challenges, as I see it, to personalized
medicine at this point is the majority of drugs to target the mutations that we’re
finding are still being given under the context of clinical trials,” Bauer said.
“We are fortunate here in Nashville to have a tremendous number of Phase 1
clinical trials at the Sarah Cannon drug development unit. So by connecting
outside referring physicians… we’re really able to help increase patient access
to potentially very effective therapies for them.”
Next Steps
For FMI customers who have yet to see the PatientMatch
module in ICE, Singal says the tool is being rolled out site by site as
institutions upgrade from ICE 1 to ICE 2. Foundation Medicine staff are
visiting sites to introduce doctors to the tool. He expects all Foundation
Medicine customers to have access to the module by year end.
As users grow, PatientMatch will “learn” as questions are
answered and the system will make sure doctors are not asked the same questions
more often than every three months or so to cut down on repetition. New changes
are already being planned. Right now treating physicians can only follow up on
individual mutations, though like patients could eventually be grouped based on
combinations of mutations, demographic factors, etc.
Within the FoundationCORE database, there’s much room for
the platform to grow, Singal says.
“There’s infinite complexity we can build in here.”