ONCODNA, Belgium – offers the OncoDEEP Plus test (R 47 500) applicable to any solid cancer of the breast, colon, lung, tongue, penis, melanoma, etc. (except bone cancer due to calcification).
This test has the ability to assess specific pathways in the tumour and can determine potential sensitivity or resistance to chemotherapeutic and biological agents. In South Africa OncoDEEP has already been used or recommended in the following settings:
• After the use of neoadjuvant chemotherapy in patients with a poor response to conventional chemotherapy.
• In the metastatic setting where patients have had prior chemotherapeutic exposure with progression or recurrence of disease.
• In patients with non-carcinomatous lesions of the breast (e.g. sarcoma and malignant phyllodes) to select the most appropriate systemic therapeutic options.
The rationale behind using this type of genomic profiling is to identify the most effective therapeutic agent up-front. In the case of the first breast cancer patient whose medical aid considered reimbursed for OncoDEEP, initial treatment of her tumour with standard Anthracycline, Cyclophosphamide regimen showed a poor response. After the second treatment, she was admitted to consider possible expedited surgery due to the concern of possible tumour enlargement.
The OncoDEEP test performed within 7 days showed deleterious mutations in three main pathways namely:
1. PIK3CA – this gene is important in controlling the cell cycle and the mutation identified causes increased activity in AKT, leading to increased cell proliferation. Currently there are no registered AKT inhibitors, although one such agent is in trial phase.
2. High expression levels of TRE3 suggested that the tumour should be sensitive to Taxanes, while low expression of AR and high levels of TS indicated possible resistance to 5-FU.
3. High expression levels of TOP2A indicated potential benefit from Antracyclines.
Based on these findings the patient continued to complete 4 cycles of antracyline chemotherapy followed by Taxane based chemotherapy. She subsequently had a very good clinical response and on final resection she only had three small foci of residual tumour in her breast. She also had residual tumour in only one out of 12 nodes with no soft tissue involvement. The OncoDEEP result led to continuation of her initial Antracycline regime avoiding premature switching to Taxanes and ensuring maximal response before surgery.
The science of medicine is ever-changing and subject to alteration as our understanding of health and disease pathways improves.