People living with cancer in the 2020s have treatment options that didn’t exist just a few decades ago. An oncologist can now order genomic sequencing of her patient’s tumor and determine whether a targeted treatment is available for that very specific cancer type.
Many of these targeted treatments are more effective in preventing the proliferation of cancer cells than older, more conventional therapies such as radiation, surgery or standard chemotherapy. Until very recently, though, access to targeted therapies was available only to patients receiving cancer care at big-city academic research hospitals.
Maine is a geographically large state with a small, mainly rural population that is also one of the oldest in the U.S., with cancer rates and mortality above the national average. To expand treatment options for Maine cancer patients, The Jackson Laboratory established the Maine Cancer Genomics Initiative in 2016 with a grant from the Harold Alfond Foundation.
Today every oncology practice in Maine is engaged in the efforts of MCGI. Participating clinicians get access to advanced genomic tumor testing, characterizing the genetic profile of each patient’s cancer. Genomic tumor boards — specialized teams of oncologists, researchers and clinicians — convene by videoconference to review patients’ test results and design personalized treatment plans for the patients. Patients also receive assistance in identifying and applying for clinical trials that are appropriate to their diagnoses.
York, Maine, is a popular seaside summer resort located just north of the state border with New Hampshire, with a year-round population of about 13,000. At York Hospital Oncology and Infusion Care there is an active clinical trials program. Clinical research coordinator Brenda Kiberd, R.N., calls MCGI a “game-changer” for the cancer patients in the practice.
Kiberd’s role is to seek out the most potentially effective treatments for each patient, including enrollment in clinical trials. “The development of genomic testing has really expanded our treatment options,” she says. “And where not too long ago only oncologists were aware of targeted treatments, now patients are not just aware of them but asking for them.”
Once a patient has agreed to genomic testing, Kiberd says, “we sign the patient into the MCGI study and send their core biopsy to JAX. When the test results come back, the physicians review them and decide whether to start the patient on a new, targeted treatment suggested from the panel results, or continue standard-of-care treatment if the patient is doing well, keeping the new treatment on hold if needed later.”
That’s what happened with a York patient who was diagnosed in 2019 with adenocarcinoma of the colon. A PET scan following a hemicolectomy showed that the cancer had metastasized to her liver. “She started on standard-of-care treatment,” Kiberd relates, “and we also enrolled her in the JAX study, which showed that the tumor was positive for PDL1 and ERBB2,” two cancer mutations. A second PET scan a few months later indicated that the patient was having an excellent response to the standard treatment.
But by June 2021, a PET scan revealed a recurrence of the cancer, and the York team presented her with the targeted treatment option. A month later, after some unrelated medical complications, the patient decided to start the new treatments. “Because we had those test results from 2019,” Kiberd says, “we were able to get her onto lapatinib and trastuzumab. As of the end of December 2021, her PET scan showed she’s still having great results and has stable disease.”
“She’s doing remarkably well, and she’s in her 80s,” adds Marilyn McLaughlin, M.D., the patient’s oncologist. “We can use these treatments and tailor them to the patient, irrespective of age.”
McLaughlin joined York Hospital in 2014, after being a solo practitioner at her private oncology practice in Riverhead, Long Island, New York. “One of the things that has been so remarkable in working for a community hospital is how your patients are also your neighbors,” she says. “You know they are being treated closer to home and the need for local care is important.”
Prior to joining York Hospital, she was impressed by the extra mile York Oncology goes to care for their patients. “For example, our patients are provided with lunch in the oncology unit so they don't have to worry about bringing food in. If they need transportation to treatments or testing, it is provided. The Infusion Center has a dedicated social worker that helps our cancer patients with various needs, and we are currently recruiting for a nurse navigator to facilitate patient care. We have integrated with the York Hospital Living Well Center to help our oncology patients with overall wellness. As a solo practitioner, I was never able to do those things because I was so busy just treating my patients and trying to make sure that my office stayed afloat.”
McLaughlin says that when she first came to York Hospital, “not many people were getting genomic tests. They were new on the market, and while most doctors knew about them, doctors and patients alike were concerned about whether insurance would cover the treatments recommended by the testing, which they considered to be experimental.”
Today, she says, “Medicare and private insurance companies now embrace genomic testing and many targeted treatments because the outcomes have been so good. And now genomic testing is at the forefront of almost every patient's mind when they first come into my office. I think JAX and MCGI have done a tremendous job of raising awareness about testing and targeting treatments, and I think physicians and patients have benefited in a remarkable way.”
MCGI Associate Director , Ph.D., says there is still work to be done to navigate patients from test results to treatment. “If a treatment shows excellent promise for a patient’s cancer but has not yet been approved by the FDA for that particular tumor type, it can be very challenging to get insurance coverage.”
Facilitating enrollment of Maine patients in clinical trials for new treatments is another challenge, given the state’s dearth of academic research hospitals. “That is something that I think MCGI is going to get a lot better at helping with over the next two or three years,” Graham says.
MCGI also provides participating Maine oncologists with educational programs in cancer genomics and precision, developed by the JAX Clinical & Continuing Education team, as well as hosting an annual forum and distributing a quarterly newsletter.
Some rural Maine oncology practices “don’t have the resources” to manage research studies for their patients in additional to providing focused, quality patient care, Graham says. “That’s where the MCGI team comes in, to help these smaller practices get past that hurdle to help their patients with advanced testing and treatment.”
is MCGI’s clinical research coordinator, working with six practices in rural Northern Maine and eight Maine oncology study sites, including York Hospital. “Providing patients with access to these types of tests is an extra step of hope for them,” Gaitor says.
Gaitor was born and raised in Madawaska, near the Canadian border in Maine’s largest, most rural and northernmost county, Aroostook. “When I enroll patients, I know where they’re coming from when they tell me that this genomic testing is so new to them,” she says. “And I’m happy that we’re making a step forward to providing them with the kind of access and treatment options that people in more populated areas of the world have.”