Manipulating Data to Make Precision Medicine Magic

Data and technology continue to reshape how we live and do business, and nowhere is this more evident than in healthcare. When the clinical and technological minds at Duke Cancer Network, Duke Cancer Institute’s Department of Pathology and Duke University Health System’s clinical laboratories in Durham, N.C., came together to form the Precision Cancer Medicine Initiative five years ago, they had a vision to better maximize the interoperability of key clinical and tumor genomic information of patients for improved cancer care. As precision medicine continues to evolve and expand, institutions like Duke Cancer Institute are diligently pursuing the power of data and technology to drive real solutions for multidisciplinary cancer care teams and their patients.

The result: the wildly successful molecular tumor board, innovative frameshift molecular registry of tumors (frameshift MRT), and highly coveted membership and collaboration with the American Association for Cancer Research’s Project GENIE (Genomics Evidence Neoplasia Information Exchange)—all of which has placed Duke Cancer Institute at the forefront of clinical data magic.

When John Strickler, MD, medical oncologist and associate professor of Medicine at Duke Cancer Institute, recently sat down with ACCCBuzz to talk about molecular profiling and data, he shared details about the cancer institute’s journey. Like so many institutions around the country five years ago, precision medicine was just gaining popularity and processes were disjointed; there was a significant amount of variability throughout Duke Cancer Institute in terms of ordering practices and standard operating procedures. 

As oncologists increased their ordering of comprehensive genomic profiling tests, also known as next-generation sequencing (NGS), one of the primary challenges they faced was the use of multiple vendors, which caused variances in processes and results would be received in various formats (e.g., printed documents, faxes, documents requiring scanning, etc.). Consequently, data and valuable opportunities were lost. Few patients were receiving appropriate biomarker-directed clinical trials despite eligibility, and, in many cases, clinicians were simply unaware these trials were open. As Dr. Strickler described, “Five years ago, if you looked at one of our largest basket trials of molecularly matched therapies, we should have had 20 percent of our patients eligible. But we underperformed expectations. In some cases, clinicians were unaware that a trial was available. In other cases, clinicians were unaware that their patient met molecular eligibility. And it’s indicative of the challenges of molecular profiling.”

To rectify this, one of the first things Duke Cancer Institute did was mandate the use of designated vendors. If cancer care teams were going to order NGS testing through the health system, they had to use one of Duke Cancer Institute’s designated NGS and germline vendors. These companies are able to supply results in a structured data format that can be internalized by the frameshift MRT, affectionately referred to by Duke Cancer Institute staff as “Mr. T.” 

Once data were available in the molecular registry of tumors, clinical teams could explore personalized treatments and therapies, screen for up to 400 genomic alterations (for solid tumors), identify patients who could be eligible for a newly U.S. Food and Drug Administration (FDA)-approved and targeted therapies, or identify patients for clinical trials. The impact has been tremendous. 

In real-time, this has equated to over 34,000 tests ordered across the entire health system. And with recent efforts to incorporate local community hospitals, this number is only growing. Data can be filtered down and manipulated in multiple ways to convey key information like patient volume, test type, variant type, patient demographics (e.g., race, ethnicity, etc.), major disease groups, vital status, repeat testing, and more—all on a gorgeous, intuitive Tableau dashboard. Moreover, through Duke Cancer Institute’s collaboration with the GENIE consortium, clinical teams now have access to over 150,000 patients across the consortium.

But the work is not done. Duke Cancer Institute has recognized the need to expand outreach across its network. “There’s a real need in terms of health equity to ensure that patients in these rural community hospitals are getting more access to NGS testing and equal access to FDA-approved and investigational therapies,” remarked Dr. Strickler. Furthermore, with a vision to move beyond genomic data, the cancer institute has high hopes to integrate other components over time, such as treatment information and payer claims.

The bottom line: data has the potential to change lives. By improving something as simple as results reporting, the doors to genomic profiling data accessibility are thrown wide open and, as a result, patient outcomes are improving daily.  

For more information on precision medicine in oncology, visit the ACCC Precision Medicine Stewardship program website or contact Rifeta Kajdic Hodzic, ACCC program manager. 

The ACCC Precision Medicine Stewardship education program is supported by AstraZeneca and Blueprint Medicines.