Precision Genomics

Understanding Precision Genomics

At IU Health, precision genomic testing looks at the genetic structure of your tumor as well as your normal DNA. This helps us discover “actionable” mutations that can be targeted with therapy. These discoveries can lead to new treatment recommendations that treat your cancer more effectively on a personalized level.

Who's Eligible?

Patients eligible for genomics treatment are adult patients who have a solid tumor that has been deemed appropriate for this type of treatment by their current physician. Patients must be referred into the IU Health Precision Genomics Program.

Genomic vs. Traditional View of Cancer

Traditionally, cancer has been defined by where on the body the cancer started (i.e., breast, lung, skin, etc.). At its core, cancer is really a disease of the DNA. Cancer is caused when we develop certain mutations in the DNA of a cell. These mutations get copied over and over as cells divide, and this leads to cancer.

There are some surprises when we examine cancer at the genomic level. For example, there are some forms of breast cancer that look more like ovarian cancer. Some patients with prostate cancer have a genetic mutation most often associated with breast cancer. Precision medicine has revealed many examples like these. This knowledge has shifted our thinking about cancer more toward considering what drives a specific type of cancer rather than where on the body it began.

Why IU Health for Precision Genomics

The IU Health Precision Genomics program is changing cancer care by partnering with you.

• Your doctor remains your doctor, and together you will decide which recommendations to pursue and when
• You can remain close to home with our convenient locations across central Indiana
• You and your doctor get access to the most leading-edge science in genomic testing
• You and your doctor get access to highly specialized experts where science meets the art of interpretation—this includes multidisciplinary clinical conference review, personalized recommendations and education
• You and your doctor can receive assistance with pursuing approval for genomic-directed therapy recommendations, if needed

Understanding genomic testing at IU Health

To understand how we study your DNA through genomic testing, it helps to understand what a genome is.

The genome is a three-billion-letter blueprint of every cell in your body. Cells are constantly dividing to replenish themselves, but sometimes–like an old copy machine–the copying process has a typographical error. In genetics (the study of genes), we call these errors “mutations.” If you get one typo in the wrong place, the cell can’t follow its instruction manual anymore and it misbehaves. This is cancer.

Cancer is a disease of mutations (or typos) in your genetic blueprint. Through scientific research, we can now read that entire, 20,000-gene blueprint to understand where the typos are located. This helps us understand more about potential vulnerabilities in your cancer. Over the last decade, there’s been an explosion in cancer medications that target these cancers in different ways. By understanding your blueprint, we can personalize therapies to target the specific vulnerabilities within your cancer.

Genomic testing also tells us details about what you have inherited from your parents. Not only is this helpful information for choosing for the best cancer treatment for you, we might also learn something about your family members’ likelihood to develop cancer. If we identify something they should know, we will direct them to the appropriate testing.

Our Approach to Precision Genomics

What to Expect

Once your doctor refers you to IU Health Precision Genomics, you’ll meet with a team at a nearby IU Health location for an initial consultation and testing. A tissue sample of your DNA will go to a leading-edge laboratory, where your DNA will be sequenced to better understand a few things about you. This includes analyzing:

1. The DNA of your cancer to determine the best available treatment options for you while minimizing your potential for negative side effects.
2. Your healthy DNA to evaluate whether you have an inherited genetic change that puts you at risk for cancer. Our team will help identify if those exist, how they may impact your therapy and whether your family members should be screened for this mutation.

The findings will be analyzed by a Clinical Conference team. This includes more than 20 multi-disciplinary IU Health and Indiana University School of Medicine faculty and staff, including oncologists, genomics scientists, pathologists, pharmacy specialists, nurses and clinical trial specialists. This team also reviews your medication list to check for any potential genetic predispositions to higher side effects from the drugs you are taking.

There is no one-size-fits-all plan. After much deliberation, the Clinical Conference team will make a treatment recommendation to your physician. This recommendation considers best standards of care, as well as new and innovative treatment options that may be appropriate for you.

Precision genomics treatment

After the clinical conference team outlines their recommendations, you will have another appointment at a nearby Precision Genomics clinic or virtually. You and your oncologist will review the team’s recommendation. Our goal is to give your doctor a whole tool kit of options to use in approaching your care so you both can decide how best to proceed and when. We will work hard to help your physician select the best therapy for you and help plan how to effectively use that treatment to give you the best quality of life going forward.

It’s important to know that your treatment may not begin right away. For patients with metastatic disease, or those with pancreatic and ovarian cancer, you may begin germ line testing of your tumor on day one. But many patients will simply be gathering more information about their DNA to help their doctor plan the next step in care.

Research

Every patient who comes through IU Health Precision Genomics is offered a place in our observational study, where we follow patients through the rest of their cancer journey. Through this research, we can share information from what we’ve learned through your testing and treatment to advance the study of and understanding of cancer.

Some of our current clinical trials include:

Evaluating Disparities in Precision Oncology (EDPO)

Every patient in IU Health Precision Genomics is offered a place in EDPO, our observational study, in which we follow patients through the rest of their cancer journey. Through this research, we can share information from what we’ve learned through your testing and treatment to advance the study of and understanding of cancer.

Total Cancer Care®

Total Cancer Care® is an ongoing study collecting medical information, tissue, blood and other specimens from people with cancer, people at risk of having cancer and people who know someone with cancer. This information helps scientists make important discoveries to develop personalized cancer care options. This study collects samples at several leading cancer centers across the country.

Search IU School of Medicine Clinical Trials

IU Simon Comprehensive Cancer Center hosts hundreds of ongoing clinical trials that need participants. Search the database of studies and talk with your doctor about whether one of these clinical trials is right for you. Many of these studies are led by IU researchers and available at sites across the nation.