UPMC among 7 facilities in nation using advanced gene technology in cancer fight
By Luis Fábregas
Published: Saturday, Nov. 2, 2013, 12:01 a.m.
Kathy Bilinsky had undergone three years of failed lung cancer treatments when her oncologist proposed an unconventional test.
Using a machine the size of a cooler, doctors at UPMC analyzed millions of fragments of DNA from her cancer cells.
They hit a jackpot, finding genetic mutations that led them to treatment they hadn't considered — which worked.
Scans show her cancer has stopped growing, she said.
“I am lucky,” said Bilinsky, 64, a retired teacher from North Huntingdon. “If my luck only holds for a couple of months, that's better than not having any luck at all.”
Such advanced genetic testing is not about luck. It is precise and fast, and it's changing the way physicians approach common and deadly cancers, medical experts say. Not only can it help doctors identify drugs that work against mutations, it allows them to rule out drugs.
“It's a revolution,” said Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society. “We're finding things we never expected. We never had that power before.”
UPMC is the only hospital in Western Pennsylvania and among seven facilities in the country using the technology for clinical purposes, according to hospital officials and a trade journal.
Though scientists have been able to sequence DNA for years, these machines allow them to look at millions of DNA fragments at a time. Their goal is to uncover genetic alterations that are linked to cancers and influence how cancer cells divide, spread and die. For example, the presence of the BRCA gene mutation increases the risk of breast and ovarian cancer.
Doctors in Pittsburgh are using machines to produce a personalized cancer mutation panel targeting 2,800 mutations in 50 cancer genes, said Dr. Yuri Nikiforov, director of UPMC's division of molecular and genomic pathology.
With a molecular profile, doctors pore over a database maintained by the National Institutes of Health that details clinical trials nationwide for patients with specific mutations, Nikiforov said. Some doctors who treat melanoma, breast, colorectal, lung, brain, ovarian and renal cancers have used the genetic testing for patients who exhausted possible treatments.
Most insurance plans cover use of the panels for diagnostic purposes to fight cancer and reduce costs. If they're not covered, testing can cost $2,000 to $3,000, he said.
“We're finding new therapeutic targets that would've never been used if we didn't have this test,” Nikiforov said.
That's what happened in Bilinsky's case. In 2010, a CAT scan revealed cancer had spread from her lungs to her adrenal glands. She was treated with carboplatin, a chemotherapy drug, and later with radiation. She'd had surgery, which meant doctors stored some of her tissue.
Her oncologist, Dr. Mark Socinski, opted to analyze the tissue cells in a machine made by New York-based Life Technologies, called the Ion Torrent. UPMC purchased three such machines for about $100,000 each and placed them in its $39 million Clinical Labs Building in the city's Oakland neighborhood.
The analysis found a mutation reported only once in lung cancer but associated with a class of drugs called mTOR inhibitors, used to treat kidney and other cancers. Not knowing if the drugs would work against Bilinsky's type of cancer, they obtained approval from her health insurance company.
“I've been doing this 20 years, and I have not very commonly seen the response that this lady had,” said Socinski, co-director of the UPMC Lung Cancer Center of Excellence. He said he was least impressed by her improved scans and more impressed by Bilinsky's ability to bounce back and resume her daily routine.
“This is amazing,” Socinski said. “You kind of become addicted to genetic testing because when you find these patients, you can make such a difference.”
Experts, however, caution that sophisticated genetic tests give information, not treatment.
“The test doesn't cure anybody,” said Dr. Carlos Arteaga, president-elect of the American Association for Cancer Research and professor of medicine and cancer biology at Vanderbilt University in Nashville. “We are scratching the surface. It might find a lot of mutations that mean nothing.”
Socinski agreed and cautioned that some gene alterations, which can arise spontaneously during a person's life, might be meaningless in helping some patients. But that hasn't stopped some doctors from using the genetic panels, even on patients with newly diagnosed cancers.
That's the case at the University of Pennsylvania's Abramson Cancer Center, where doctors used the testing in about 500 cases, said Dr. David Roth, chairman of pathology at Penn Medicine. The center's goal is to test all of the nearly 7,000 cancer patients treated there every year, he said.
“No matter what kind of cancer you have, you want to get information like this so that you can potentially benefit if you're one of the people that have one of those mutations,” Roth said.
Bilinsky, who continues to undergo chemotherapy, knows her cancer could roar back. She stays active, bowling once a week and taking yoga classes, and hopes to ski this winter.
“I keep hoping they keep me alive long enough to find a cure,” she said.
Luis Fábregas is a Trib Total Media staff writer. Reach him at 412-320-7998 or firstname.lastname@example.org.
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