Each person's cancer has a unique combination of genetic changes, and the sequencing of the tumor's DNA is one way to identify these changes. Knowing the genetic alterations of a cancer can help determine a personalized treatment plan with greater precision. Some treatments, especially some targeted therapies, are effective only for people whose cancer cells have specific genetic alterations that cause cells to grow uncontrollably (also called "driver" mutations).
At QuironSalud Valencia, we offer our patients the possibility of benefiting from precision oncology through the reliability of the FoundationOne test. FoundationOne is a high quality DNA sequencing test, validated in multiple studies and the only one approved by the US FDA. This test analyzes, in a complete way, 315 genes involved in cancer, detecting all types of mutations that can direct tumor growth. Tumor mutation burden (TMB) and microsatellite instability (MSI), important biomarkers that predict the benefit of immunotherapy, are also reported. In this way we obtain a comprehensive genomic report of the tumor that helps us make decisions in complex clinical situations. The FoundationOne test is performed on a sample of tumor tissue, ideally on a recent metastatic lesion. In circumstances in which it is difficult to obtain tumor tissue, a liquid biopsy can be performed and analyze, in the blood, using the Foundation ACT test, the circulating tumor DNA of the 62 most important genes involved in cancer.
Who can benefit from the FoundationOne-Foundation Act test?
Personalized oncology goes beyond performing a genetic test on the tumor. The FoundationOne test makes more sense and is more effective when it is integrated into the therapeutic and evolutionary context of each case. In Quirónsalud Valencia we evaluate in a multidisciplinary committee the oncological history of the patient to determine if he/she benefits from the FoundationOne test or, if on the contrary, another oncological action of a therapeutic or diagnostic nature would be more convenient. However, we consider that the test is particularly indicated in the following situations:
- Patients with aggressive stage IV solid tumors that have exhausted the standard treatments, according to the treatment guidelines, and the molecular tests required, but which maintain a good general condition.
- Patients with stage IV non-small cell lung cancer without known mutations or progression to targeted therapies.
- Patients with rare stage IV solid tumors who have limited options for systemic treatment according to clinical guidelines.
- Patients diagnosed with cancer of unknown primary location.
What results can I expect from this study?
The result of the sequencing will be evaluated again in a multidisciplinary committee and you will receive a report with the genomic alterations detected in your tumor and the targeted therapies or clinical trials more suitable according to the scientific evidences. The sequencing of the tumor can originate 4 types of results with therapeutic implications:
- A driver alteration is detected with a drug already approved for your tumor. This situation is the one which is most favorable and easy to interpret.
- A driver alteration is detected with an approved drug but not for its tumor. In this case, there is the option of making an unauthorized use of the drug, that is, prescribing the medication but with a different purpose than the one approved. This practice is called "off-label" because the medication, although it is safe, is being used in an indication that is not described in the package leaflet. Research has shown that the use of unapproved drugs is very common in the treatment of cancer.
- A driver alteration is detected with a drug that is being investigated in a clinical trial. In this case we will inform you of where the clinical trial is being conducted and if you meet the criteria to be treated with the drug.
- No driver alteration susceptible to being treated is detected. In this case, we will keep you informed in case any future therapy arises.
What steps do I need to take to have my case evaluated in the precision oncology committee?
You or the doctor or institution that is treating you can do it, and it can be done in person or remotely. You must provide a complete report of your cancer history, including copies of radiological evaluations and pathology reports. The committee will evaluate and determine if your case benefits from the FoundationOne test. If this is not the case, you will receive a report with the therapeutic recommendations or the necessary diagnostic extensions that can help to make clinical decisions. If indicated, or chosen, by the FoundationOne test, a biopsy of the metastatic disease should be provided/performed or, failing that, a blood sample should be obtained. Samples are sent to the central laboratories of FoundationOne, obtaining results in 2-3 weeks. Once submitted to the committee, we will analyze the current scientific evidence for each of the genetic alterations found and we will contact you to explain the therapeutic findings and recommendations.