When Gwen Brack was a junior in college, she was diagnosed with stage IV rectal cancer. She sought treatment, but the cancer soon returned and then spread to her liver and bladder. She underwent rounds of chemotherapy and nine surgeries, but the cancer kept growing.
Eventually, she was referred to Indiana University Health’s precision genomics program, where an analysis of her genetics was performed. IU’s doctors found a mutation in her tumors known to respond to aspirin, so they put her on a daily dose, believing it would be more effective than chemo.
Today, Brack is celebrating one year of being cancer-free and sharing her story at a ribbon-cutting ceremony for a new precision genomics clinic at IU Health. The precision genomics program, established in 2014, has so far treated more than 1,700 patients.
As doctors learn more about harnessing a person’s genetic code to treat diseases like cancer, it’s become a hot area in healthcare. IU’s health system, one of the busiest in the country, hopes that expanding precision genomics will lead to better treatment outcomes for patients across the state.
Will Hundley, executive director of the precision genomics program, says the effort began organically a few years ago with a couple of doctors shepherding the new technology internally. “In 2016, we hit an inflexion point,” he says. “The decision was made to create a stand-alone service line for precision genomics, which is pretty rare in the U.S.”
The program does have some unique aspects. IU’s doctors sequence all 22,000 genes in a person’s genome, including genes of the tumor as well as healthy tissue. Most tests, Hundley maintains, look at less than 400. Patients are referred into the program from around the country, and they receive a treatment plan recommended by a multidisciplinary team of specialists for their home oncologist to follow if they aren’t local. But perhaps most unique is the weekly tumor board meeting, where a group of 20 “thought leaders” analyzes each patient’s data.
“Amazing people contribute to each patient plan,” Hundley says. “They’ve all got day jobs and still meet every week to review cases.”
Hundley says that out of the patients treated at IU Health’s clinics so far, only one has had to pay for sequencing, and that was only because he had an exceptionally high income. Insurance companies don’t cover much when it comes to precision genomics, so the vendors that IU Health contracts with to test biopsy samples cover the majority of the cost.
“Generally, because genomic data is so rich for research, testing vendors have really generous patient assistance programs,” he explains. IU Health helps with upfront costs if needed.
Hundley expects the program to treat roughly 600 patients in 2018. “Not many programs nationally are doing that kind of volume,” he adds. He hopes to eventually expand IU Health’s precision genomics footprint to other healthcare systems outside of Indiana and establish more advanced cancer clinical trials in-state.
There are currently four IU Health precision genomics clinics operating in Indianapolis, Bloomington, Lafayette, and Muncie. Today’s ribbon-cutting celebrates the opening of a fifth clinic in Carmel.