Next-Generation Sequencing (NGS) combined with and Immunohistochemistry (IHC) and other oncogenomic assays:3 OncoDEEP Test Options
1. OncoDEEP NGS: DNA- and RNA sequence analysis, excluding IHC
2. OncoDEEP NGS+IHC: Specific to cancer type, non-related to chemotherapy
3. OncoDEEP Premium: All of the above, with extended IHC including chemotherapy predictive testing
A unique combination of leading-edge tests
OncoDEEP provides clear clinical guidance for patients with any solid cancer type, including aggressive and rare cancers at diagnosis, after resection, when the cancer does not respond to chemotherapy or comes back.
Why choose OncoDEEP?
- Map out the cancer treatment options that match each patient’s unique tumor profile
- Reveal early indication of treatment resistance and spare non-responders toxicity of a treatment with no therapeutic benefit
- Reduce cost of testing by replacing sequential biomarker testing with comprehensive analysis that delivers results faster and more cost-effectively
- Uncover opportunities to access drugs and clinical trials by leveraging a proprietary, curated and up to date database and international networks leveraging clinical trial platforms
- Increase patients’ understanding and access to complementary germline testing and clinical trials
- Publish patient case studies and develop effective service delivery protocols as part of a multi-disciplinary team
In what scenarios are OncoDEEP useful?
- Available for all solid tumors in adults and glioblastoma in children
- Recommended for early stages NSCLC after complete resection
- Recommended for maintenance treatment of patients with advanced ovarian cancer
- Recommended for stage III or stage IV cancer patients
- At initial diagnosis
- At disease progression after first-line treatment
- In case of a highly aggressive cancer or rare cancer type
- When primary location of the tumor is unknown
OncoDEEP Report
The OncoDEEP report helps oncologists understand how likely it is that an individual patient will respond to a specific treatment and flag potential resistance mechanisms.
Each report:
- Summarizes result in one page with clear indication of patient sample information and genomic findings
- Presents detected variants with clinical significant associated with potential therapeutic impact (or lack of) according to FDA/EMA/NCCN/ESMO guidelines and/or based on our proprietary database
- Is actionable, concise and help inform therapy decisions according to the most recent clinical guidelines
- Aids in fuelling research, by contributing and building clinical evidence, uncovering potential targets for cancer drug development
Examples:
- Diagnosis: Metastatic non-small cell lung cancer (NSCLC) – female in early 30s
OncoDEEP result: METex-14 skipping
Treatment decision: Capmatinib or tepotinib.
- Diagnosis: Pancreatic cancer – male with no family history of cancer
OncoDEEP result: After using a 45-gene NGS panel that was uninformative, comprehensive testing revealed a positive HRD status (Homologous Recombination Deficiency) in the absence of a BRCA mutation.
Treatment decision: Enrolled in a clinical trial of irinotecan, rucaparib, fluorouracil and leucovorin.
- Diagnosis: Cancer of unknown primary – elderly female
OncoDEEP result: Microsatellite Instability (MSI-high) and a high Tumor Mutational Burden (TMB-high).
Treatment decision: Enrolled in a clinical trial focused on an innovative combination of immunotherapies (tiragolumab + atezolizumab).
Follow-up: In just one month, the patient showed a partial response with a 25% decrease in the tumor size.
OncoDEEP: Step by step
The Gknowmix support team working in close collaboration with at OncoDNA in Belgium can assist with the decision on the relevance of tumour NGS, how to process the sample for testing, and in understanding the clinical recommendations made in the report. Testing can be performed on any solid cancer of the breast, colon, lung, tongue, penis, melanoma, etc. followed by a liquid biopsy test if clinically indicated.
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 initially been used or recommended in the following settings and may more over the last 6 years:
• 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.
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