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Industry Trends: Molecular Diagnosis Business Points to Growth


BRCA and Beyond: A Genome-first Approach to Familial Breast Cancer Risk Assessment

Abstract: Breast cancer affects around 12% of women in the Western world, but individual lifetime risks vary significantly within any population. Currently, familial cancer services assess and manage familial breast cancer risk based on the presence of a family history of the condition or the identification of high-risk breast cancer susceptibility alleles. This model of clinical care provides an accurate genetic risk assessment for only the minority of families referred to these services. With increasing access to technologies that interrogate human variation at the genome-wide level, it is envisaged that familial breast cancer risk assessments will in the future assume a genome-first approach. This review discusses and highlights the different components of familial breast cancer risk, which will need to be integrated to make this new model of clinical risk assessment possible. ... Read more

Implementation of Biomarker-Driven Cancer Therapy: Existing Tools and Remaining Gaps

Abstract: There has been growing interest in biomarker-driven personalized cancer therapy, also known as precision medicine. Recently, dozens of molecular tests, including next generation sequencing, have been developed to detect biomarkers that have the potential to predict response of cancers to particular targeted therapies. However, detection of cancer-related biomarkers is only the first step in the battle. Deciding what therapy options to pursue can also be daunting, especially when tumors harbor more than one potentially actionable aberration. Further, different mutations/variants in a single gene may have different functional consequences, and response to targeted agents may be context dependent. However, early clinical trials with new molecular entities are increasingly conducted in a biomarker-selected fashion, and even when trials are not biomarker-selected, much effort is placed on enrolling patients onto clinical trials where they have the highest probability of response. We review available molecular tests and therapy discerning tools, including tools available for assessing functional consequences of molecular alterations and tools for finding applicable clinical trials, which exist to help bridge the gap between detection of cancer-related biomarker to the initiation of biomarker-matched targeted therapies. ... Read more

Systems Approaches to Molecular Cancer Diagnostics

Abstract: The search for improved molecular cancer diagnostics is a challenge for which systems approaches show great promise. As is becoming increasingly clear, cancer is a perpetually-evolving, highly multi-factorial disease. With next generation sequencing providing an ever-increasing amount of high-throughput data, the need for analytical tools that can provide meaningful context is critical. Systems approaches have demonstrated an ability to separate meaningful signal from noise that arises from population heterogeneity, heterogeneity within and across tumors, and multiple sources of technical variation when sufficient sample sizes are obtained and standardized measurement technologies are used. The ability to develop clinically useful molecular cancer diagnostics will be predicated on advancements on two major fronts: 1) more comprehensive and accurate measurements of multiple endpoints, and 2) more sophisticated analytical tools that synthesize high-throughput data into meaningful reflections of cellular states. To this end, systems approaches that have integrated transcriptomic data onto biomolecular networks have shown promise in their ability to classify tumor subtypes, predict clinical progression, and inform treatment options. Ultimately, the success of systems approaches will be measured by their ability to develop molecular cancer diagnostics through distilling complex, systems-wide information into actionable information in the clinic. ... Read more

Integration of Genomics into Medical Practice

Abstract: Although some have wondered whether the sequencing of the human genome has led to major advances in medicine, in fact there are multiple examples where genomics has been integrated into medical practice. In the area of prevention, genomic approaches are now used for non-invasive prenatal testing of fetal DNA in the maternal circulation, for expanded preconceptional screening for carrier status, for autosomal recessive disorders, and for assessment of risk of common disease. In the area of diagnosis, major advances have been made in cytogenomics and in use of whole exome or whole genome sequencing. In therapeutics, pharmacogenetic testing is now feasible, tumor genome sequencing is being used to guide cancer therapy, and genomic discoveries are enabling development of new targeted therapies. Ultimately it is possible that genome sequencing may be done for all individuals on a routine basis, though there remain significant technical, ethical, and medical systems challenges to be overcome. It is likely that integration of genomics into medical practice will occur gradually over a long period of time, but the process is now well underway. ... Read more

Personalized Cancer Treatment and the Myth of KRAS Wild-type Colon Tumors

Abstract: The impact of KRAS mutations on the efficacy of therapies that target the epidermal growth factor receptor (EGFR) is a major, ongoing area of oncology research, aimed at identifying the best possible treatments for individual colon cancer patients. Because patients with KRAS mutant colorectal tumors rarely respond to anti-EGFR monoclonal antibodies, testing is required to confirm the patient's tumor is KRAS wild-type before utilizing these therapies. Despite being studied for more than 30 years, new information continues to develop regarding KRAS and its role in colon carcinogenesis. This information must be integrated into the development of effective colon cancer treatment strategies. This review will summarize recent evidence that most, if not all, colon tumors encompass at least a subpopulation of KRAS mutant cells, meaning tumors characterized as KRAS wild-type are in most cases tumors with relatively low KRAS mutant tumor cell content. Recent studies support the hypothesis that relapse in advanced colorectal patients treated with EGFR-targeted monoclonal antibody therapy involves the outgrowth of previously undetected KRAS mutant tumor cell populations. Studies investigating the effects of oxidative stress on Ras signaling suggest that the frequent presence of minor KRAS mutant tumor cell populations may be a consequence of hypoxic conditions within tumors, which produce a negative selection against KRAS mutant cells in polyclonal tumors. Thus, the literature and current practices for characterizing tumor KRAS mutation don't accurately reflect the nature of colon tumor KRAS mutation, even though an accurate understanding is critical for identifying the best strategies for intervention. ... Read more

Mitochondrial tRNA-Serine (AGY) m.C12264T Mutation Causes Severe Multisystem Disease with Cataracts

Abstract: Progressive multisystem disease should invoke consideration of potential mitochondrial etiologies. Mitochondrial disease can affect any organ system at any time, particularly involving neurologic, cardiac, muscular, gastroenterologic, and/or ophthalmologic manifestations. We report here a 19-year-old Caucasian man who was followed since birth in multiple pediatric subspecialty clinics for myelomeningocele complications. However, he progressively developed a host of additional problems that were not readily attributable to his neural tube defect involving developmental, ophthalmologic, cardiac, muscular, endocrine, and intermediary metabolic manifestations. Clinical diagnostic testing limited to analysis for common point mutations and deletions in his blood mitochondrial DNA (mtDNA) was not revealing. Skeletal muscle biopsy revealed abnormal mitochondrial morphology and immunostaining, mitochondrial proliferation, and mildly reduced respiratory chain complex I-III activity. Whole mitochondrial genome sequencing analysis in muscle identified an apparently homoplasmic, novel, m.12264C>T transition in the tRNA serine (AGY) gene. The pathogenicity of this mutation was supported by identification of it being present at low heteroplasmy load in his blood (34%) as well as in blood from his maternal grandmother (1%). The proband developed severe nuclear cataracts that proved to be homoplasmic for the pathogenic mtDNA m.12264C>T mutation. This case highlights the value of pursuing whole mitochondrial genome sequencing in symptomatic tissues in the diagnostic evaluation of suspected mitochondrial disease. Furthermore, it is the first report to directly implicate a single mtDNA mutation in the pathogenesis of ocular cataracts and clearly illustrates the important contribution of normal metabolic activity to the function of the ocular lens. ... Read more

BRCA1 and BRCA2 Mutations and Breast Cancer

Abstract: Genetic testing for BRCA mutations is expanding in clinical oncology centers worldwide. Testing may help target unaffected high-risk women for prevention and/or close surveillance and may also help affected women choose the best chemotherapy. Annual screening with MRI appears to be an effective surveillance strategy and should be added to mammographic screening. It is important to have an understanding of the pathologic features and the natural history of BRCA-associated breast cancers in order that individualized treatments can be developed and delivered. The goals of treatment for a woman with a BRCA-associated breast cancer should be to prevent recurrence of the initial cancer and to prevent second primary breast and ovarian cancers. Women with breast cancer and a BRCA1 mutation may benefit from tailored treatments, such as with cis-platinum or olaparib. Mutations in BRCA1 are distributed in populations throughout the world and it is important that the benefits of genetic testing and of targeted therapies be made available to women who live outside of North America and western Europe. ... Read more

What Is the Role and Impact of Molecular Markers on Treatment Decisions for Colorectal Cancer in the Adjuvant Setting?

Abstract: The new mantra for delivering optimal cancer treatment is "personalized care." This extends beyond the holistic to using germline and somatic tumoral mutations to link a specific therapy to some prognostic or predictive factor which defines a particularly responsive patient subgroup who might benefit most from treatment. Furthermore, inherited polymorphisms have the potential to greatly modulate the side effects of treatment, especially for chemotherapy which has a notoriously narrow therapeutic window (Walther et al., 2009). ... Read more

How Can Systems Pathology Help Us Personalize Cancer Therapy?

Abstract: Cancer is a complex and heterogeneous disease which changes over time, and in the face of therapeutic intervention. Single tissue biomarkers, while partially successful in helping us understand which patients will respond to therapy, cannot hope to capture this amazing complexity. Systems pathology, which combines measurements made on tissues with new mathematical modelling approaches, permits the testing of new agents and biomarkers in silico through computational analysis. These approaches help us to refine pathological measurements and improve decision making about therapies for clinical trial planning and ultimately personalized therapy. ... Read more

A Blood-based DNA Test for Colorectal Cancer Screening

Abstract: Early detection of colorectal tumors through the identification of mutant DNA in serum or plasma could have a substantial impact on morbidity and mortality. Somatic mutations are specific biomarkers for neoplastic cells, but their detection requires sensitive assays, as the number of circulating mutant molecules is small compared to the number of normal DNA molecules. A newly developed method can provide this sensitivity and at the same time precisely quantify the fraction of mutant molecules present in the clinical sample. Using this technology, it has been found that more than half of patients with early stage disease contain mutant DNA in their circulation. ... Read more

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