Genomics in Cancer Care Doesn't Always Lead to Clear Treatment Answers

Guest Author: Davendra Sohal, MD, MPH

A very well-written recent news story in The New York Times, "When Gene Tests for Breast Cancer Reveal Grim Data but No Guidance," described critical elements of the role of genomics in cancer care, and the problems that doctors face while making decisions in this rapidly evolving field. Several points are noteworthy. 

The article mentions the two components of genomics: sequencing a person's own DNA to find genes (such as BRCA) associated with heritable cancers, which can lead to further testing/treatment of the person and/or family members to prevent/find cancers; and sequencing a person's tumor DNA to find genes (such as HER2, BRAF, etc.) for which drugs can be used to treat that cancer.

Further, it is unclear on how to treat cancer when such genes are found. Data are emerging, and the science of genomic testing has far outpaced clinical trial data on what to do with the results. Ongoing "basket" studies such as NCI MATCH, ASCO TAPUR, etc., should provide some answers in the coming years. 

Finally, financial and psychological costs associated with testing, treatment, and unclear implications must be considered. At this time, a multidisciplinary patient-centered approach is critical for management of these issues. Across the institutions of the Case Comprehensive Cancer Center (Cleveland Clinic and University Hospitals), we are well along this exact path of cutting-edge cancer care, with a coordinated approach of tumor genomic sequencing, weekly genomics tumor board, basket trials, and a cancer genetics clinic.

Davendra Sohal, MD, MPH is an assistant professor of hematology and oncology, and director of the Clinical Genomics Program at the Cleveland Clinic.