NEW YORK (GenomeWeb) – Personalized medicine firm Perthera announced a partnership with patient advocacy group Lung Cancer Alliance this week through which it will facilitate molecular testing of lung cancer patients.
The arrangement gives Perthera the opportunity to expand the scope of its molecular profiling work while helping the LCA provide more patients access to such testing.
Expanding access to molecular testing among lung cancer patents is particularly relevant at this moment given the increasing number of treatment options, many of which rely on gene and protein markers, Jennifer King, director of science and research at LCA, told GenomeWeb this week.
"If you are a first-line patient diagnosed with metastatic lung cancer, there are a lot of different [treatment] choices depending on your profile," she said, citing as examples treatments based on genetic EGFR, ALK, and RAS testing as well as immunohistochemistry testing for the immunotherapy marker PD-L1.
"So people should be going on these drugs based on their [molecular] testing results," she said.
At the same time, molecular testing is still not used as extensively as it could be, King said, noting that this was one of the main rationales driving LCA's partnership with Perthera.
She cited a survey of lung cancer patients last year they contacted online that found that just 75 percent of them had received some form of molecular testing.
"This was an online survey marketed to people who, for example, are on Facebook following lung cancer groups, things like that," she said. "So some of the most health-activated people, and we were only seeing 75 percent. So we thought, if this group isn't close to 100 percent, what is the rest of the community like?"
This led LCA to conduct a survey of patients calling its helpline for treatment advice. Among this group of patients, only around 50 percent had received molecular testing.And even among those who had, some were missing out on newer tests, such as for PD-L1 status, that could help inform their treatment.
"For some of the patients we talked to, their doctors just ran EGFR and ALK tests. But genomics by itself isn't [covering] it all," she said. "So we really viewed [expansion of molecular testing] as a huge need."
Perthera made the initial contact, King said, adding that LCA was aware of the company through its ongoing collaboration with the Pancreatic Cancer Action Network (PanCan), with which, she said, LCA collaborates " on policy issues and other matters of common interest.
Perthera agreed to make its molecular profiling service available free of charge to the LCA patients, "which for us was a huge plus," King said. Also appealing, she said, was the company's focus on patients outside large cancer centers where access to molecular testing is often lacking.
"Part of what we see is a major disparity in care," she said. "People being treated at major academic centers often have access to this type of testing, but a lot of lung cancer is in [patients with] lower socioeconomic [background] and more rural areas, and what we are seeing is that people in those areas are not accessing those types of tests, and you need to have this type of testing to have the proper care and treatment in this day and age in lung cancer."
Perthera was launched in 2013 by George Mason University researcher Emanuel Petricoin and venture capitalist Dendy Young, with the aim of providing cancer patients, particularly in the community setting, the sort of molecular profiling and expert interpretation typically available at major cancer centers. It calls this its Precision Cancer Analysis (PCA) service.
The company does not perform the assays itself but helps physicians access genomic, proteomic, and phosphoproteomic profiling services from outside providers, serving as an intermediary handling the many steps involved in obtaining and sending out patient tumor samples to molecular profiling firms and returning assay results.
Perthera arranges for patient biopsies, which are then handled by a partner CLIA lab and sent to outside companies for molecular testing. Perthera combines the molecular results with other patient information, all of which is reviewed and interpreted by a virtual tumor board, which then delivers treatment recommendations to the patients' oncologists.
It then collects data on the treatments the patients received and their outcomes, which it has been compiling in a proprietary database.
To date, the company has focused primarily on pancreatic cancer through its relationship with PanCan. The partnership with LCA provides the company the opportunity to move into a disease with a larger patient population and a number of opportunities to use molecular testing to guide treatment, Andrew Mignatti, Perthera's president and CEO, told GenomeWeb.
King said it remained to be seen how many patients LCA would refer to Perthera for testing but that any patient who had not yet had comprehensive molecular testing would be eligible. LCA will provide contact information of interested patients to Perthera, which will then follow up and enter those who choose to participate into its PCA service.
"We aren't really sure yet what numbers we are going to see, but I think we could send a large number," King said.
One of the goals of the Perthera testing is to help match patients with clinical trials based on their molecular profiles, she said. According to Mignatti, in its PanCan work, roughly 30 percent of the patients Perthera profiled enrolled in a clinical trial.
Currently, Perthera's PCA service combines genomic data from Foundation Medicine, proteomic data from Caris Life Sciences, and phosphoproteomic data from Theranostics Health,of which Petricoin is also a co-founder. Mignatti said that as the company expands its focus, it will also expand the types of testing it offers, where necessary.
"When we bring on new disease states, we identify who are the best players in those individual markets and how they can overlap with what we are currently doing," he said. "We evaluate what the important individual markers for the disease state are and then decide where to go."
Petricoin, who is chairman of Perthera's scientific advisory board, said that the company planned in the next several weeks to begin adding RNA-seq data and was also considering expanding its immunohistochemistry offerings.
"It is an iterative process where you listen to oncologists, you survey the scientific and medical levels of evidence that are out there," he said.
King noted that the difficulty of staying on top of fast-evolving fields like molecular testing is one factor limiting the use of the approach, particularly among community oncologists.
"All of the [cancer] fields are changing so quickly, so to be a general oncologist and keep up with all the advances is actually really difficult," she said. She also noted that many physicians remain reluctant to use molecular tests, unless the results point to a clear treatment path.
"We are starting to see EGFR and ALK testing more widely accepted than larger panel sequencing, and that is because those are [related to] the first two targeted therapies in lung cancer, so people are realizing that if they do those tests, there are drugs they can give and there is a clear clinical path," she said.
"With some of these tests where the clinical path doesn't have that high a level of evidence yet, it's just a clinical trial referral or just an off-label use, there, I think, some people may be more skeptical," she added.
King said that with the addition of markers like PD-L1, molecular testing in lung cancer is moving from being strictly genomics-based to incorporating protein data, as well. However, she said that larger proteomic panels, while drawing some research interest, still have little in the way of clinical impact.