Feb. 22, 2024

This paid piece is sponsored by Avera Health.

Cancer care is evolving to include more molecular and genetic information than ever before, allowing each case to be treated as individually as possible.

“We are looking to this as our new standard approach,” said Casey Williams, a doctor of pharmacy at Avera Cancer Institute. “Evidence-based standard care remains important, yet there’s opportunity to use the latest genomic science to study how we can improve upon standard care.”

Cancer is a disease of genetic damage. “Molecular or DNA testing in oncology will one day be routine in all aspects of care,” Williams said.

Avera began offering precision oncology approximately 10 years ago, which involved targeted treatment informed by tumor genomic sequencing. During the early years of the program, specialists saw patients with many types of cancer on a case-by-case basis, most of whom had advanced disease.

As the program evolved, Avera launched a clinical trial in 2021 known as the Avera Sequencing and Analytics Protocol, or ASAP, that offered a range of tests to inform targeted treatment earlier in the disease process. Through collaborations with several partners, patients could receive the testing without paying anything beyond what was covered by insurance.

ASAP comprehensive testing not only included tumor genetic sequencing but also the study of the whole transcriptome, or the RNA, aspects of the proteome — the map of the proteins expressed by the genome — the microbiome, or collection of microbes in the body, as well as hereditary cancer screening. “This wide range of testing gives us important insights into how the tumor developed, what’s driving it and how it has evolved over time,” Williams said.

After interruption by the pandemic and changing partnerships, Avera researchers are ready to restart ASAP.

“One of our goals is providing test results earlier to inform cancer specialists as they are making treatment decisions,” said Rachel Elsey, pharmacist coordinator for cancer genomics at Avera Cancer Institute. “Patients have their best chance at responding in the first and second lines of therapy, so having this information available when making those first treatment decisions will provide the biggest impact.”

ASAP will lead to more comprehensive tumor profiling over time with tracked outcomes, said Dr. Ben Solomon, an Avera Medical Group medical oncologist.

“This is exciting because we have that data at our fingertips and we can better understand our patient population and bring in better treatment opportunities and clinical trials that might be a good fit for our patients,” he said.

ASAP, which to date has enrolled approximately 600 patients, also includes extensive gathering of patient data that could inform future treatment. Because of the complexity of the data, the team utilizes artificial intelligence to combine genomic and genetic information with data captured in the electronic health record.

“With the amount of information we collect, we wouldn’t be able to do a reasonable analysis without AI. With AI, a future patient can benefit from the successful treatments we’re mapping out today,” Williams said.

Through ASAP, Avera is partnering with multiple laboratory/biotech companies for blood-based sequencing of the tumor, genomic sequencing of cancer tissue and immune markers, and protein analysis of the tumor cell. The Avera Genetics lab will provide pharmacogenomics and microbiome profiling, which studies how genes impact the metabolism of medications and how gut microbes affect health and disease

The pharmacogenomics work by Avera Genetics provides an important safety component, ensuring that the right dosage is given to each patient based on how they will metabolize the medication and that the particular drug being selected is a safe treatment for them.

“We have a number of different collaborators working with Avera on treatment algorithms and decision trees to predict, based on the science, what treatments would be best for each person,” Williams said.

Avera is engaging with several other companies and academic partners for other innovative options, including early detection for relapse among people at higher risk. “It’s exciting for patients. We’re developing more opportunities every day to improve cancer care and continue to learn as we go,” Williams said.

“Cancer patients often need multiple treatment options as they go through the management of their condition, and testing results can open the door to these options,” Solomon said.

For example, eligibility for clinical trials often is based on certain biomarkers.

“Casting a broad net of testing to better characterize a cancer may lead to treatment options, either on or off a clinical trial,” Solomon said.

Through research, Avera cancer care specialists continue to push for improvements in treatment.

“We consider ASAP to be groundbreaking and practice changing. That’s why we’re thrilled to enhance and expand this study at Avera,” Williams said.

Cancer patients at Avera who are interested in ASAP should talk to their cancer care provider.

Learn more about cancer care at Avera.