Hepatitis B viruses and DNA, illustration
Hepatitis B viruses and DNA. Conceptual image for viral oncogenesis. Hepatitis B viruses (HBV) can integrate into host DNA as insertional mutagens causing the activation of a cellular proto-oncogene. Integration of viral DNA into the human genome is considered an early event in the carcinogenic process and can induce, through insertional mutagenesis, the alteration of gene expression and chromosomal instability.

It’s easy to be optimistic about the future of cancer treatment these days. New drugs and genomic methods for more accurately targeting the right treatment, to the right patient, at the right time bolster this view. However, the vast majority of precision cancer therapies today are provided academic research hospitals health networks that are primarily located in major metropolitan areas. Conversely, the bulk of cancer care is delivered outside these major markets and in rural areas, leading many to worry whether these advances will ever reach the rest of the country.

But how can precision medicine be brought to smaller oncology practices and rural hospitals where both time and money are in short supply? How can oncologists outside the major cancer centers tap into the specialized world of genomic cancer care? And how will the genomic testing be made available to cancer patients, when many insurers both public and private won’t pay for the?

Those are questions a year-old initiative called the Maine Cancer Genomics Initiative (MCGI) is hoping to answer. MCGI spans the entire state of Maine and is the brainchild of Edison Liu, M.D., CEO of The Jackson Laboratory (JAX). It is funded by roughly $12 million from JAX and an $8.4 million grant from the Maine-based Harold Alfond Foundation. MCGI’s mission is to provide 1,800 genomic tests, free of charge, to cancer patients across the state to help inform treatment decisions. The initiative is also serving as a petri dish of sorts to uncover potential methods for establishing a de-centralized model of care that can bring the latest in cancer care to areas not currently participating in the genomic medicine revolution.

“The challenge is health disparities. In the U.S. we have one of the greatest medical systems in the world, except most people don’t have access to it,” said Liu. “It is an implementation problem that we have, and I take what might have been considered a deficit of being in a rural, geographically dispersed state that has some very significant economic challenges, as an opportunity to experiment in what I consider to be the next important phase of genomic medicine.”

While JAX might seem a surprise player to be leading such a program, Liu considers this an advantage for potentially identifying a new care model since JAX doesn’t “have the institutional baggage” as established medical centers.

The program tested its first patient in July, 2017, and since then has enrolled more than 110 patients. Genomic sequencing is provided by the JAX genomics facility in Farmington, CT, using its ActionSeq Plus, a targeted panel of 212 cancer related genes and 53 genes known to form fusions. Data from each test and potential personalized therapy options are delivered back to the ordering oncologist in two to three weeks.

In order to ensure physicians have the support to make use of the data returned after testing, MCGI brought on board practicing oncologist Jens Rueter, M.D., as medical director, and Andrey Antov, Ph.D., as program director. Under their guidance, MCGI has built an infrastructure to provide the education, training, and expertise necessary for each doctor to implement genomics-guided cancer care.

Antov noted that it took a full year of development work to meet with the all the oncology practices and health systems in the state to get their buy in for participation.

“The first time you bring new technology to places, many want to see if it works and to understand it. We needed to educate a lot of the participants on the subject of clinical genomics and its applications,” Antov said. “All of a sudden the doctors are no longer only surgeons or oncologists, they become molecular biologists. They need to dive into the cell and understand how the molecules interact.”

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