By Vanessa Orr

Every day, new strides are being made in cancer treatment, including in the field of medical oncology. This not only provides patients with more treatment options, but may result in a better survival rate for those with the disease – including patients with later-stage cancers.

“Right now, if someone has an advanced cancer, we can use next-generation sequencing to test for over 800 different gene mutations, which potentially gives us 800 targets to go after,” explained Kelley Kozma, D.O., a medical oncologist and the director of the Robert and Carol Weissman Cancer Center at Cleveland Clinic Martin Health. “We can use targeted therapy instead of chemotherapy, which can be much better tolerated than chemotherapy.

“For example, in lung cancer, if we find an EGFR or ALK mutation, we can provide patients with an oral treatment option instead of chemotherapy,” she added. “In more advanced cases, such as Stage 3 lung cancer, patients can undergo chemotherapy followed by targeted therapy. Survival is better in those situations once we can target those specific mutations.”

Dr. Kozma adds that even if there is not an FDA-approved therapy for a person’s specific mutation, genetic testing also provides the opportunity to detect mutations for different cancers that have FDA-therapies that could benefit the patient’s tumor. “Targeted therapy is allowing us to see options for patients that have potentially never been known before,” she said.

The cost of next generation sequencing has decreased, which has led researchers to begin testing many different areas of tumor DNA so that new, novel therapies can be developed to target these mutations. “The field is really exploding,” said Dr. Kozma. “There are new studies going on all time.

“This is the direction that oncology is headed,” she added. “Chemotherapy is like a shotgun approach to go after any cells that are dividing; gene sequencing allows us to pinpoint the mutation and target it with a specific drug used for that mutation.”

Currently, next-generation sequencing is utilized for almost all of the cancer center patients with advanced cancer, as well as patients who are elderly or who have other comorbidities that would make it difficult or impossible for them to tolerate chemotherapy.

Dr. Kozma adds that the center is also testing for PD-L1 expression in earlier stage tumors to determine how well they would respond to immunotherapy.

“Different than targeted therapy, immunotherapy is a therapeutic agent that stimulates a patient’s own immune system to fight cancer cells,” Dr. Kozma explained. “Genetic testing is where we look for mutations in a patient’s DNA within their healthy cells.”

This technology is especially well developed in the area of ovarian cancer, where if a patient has a genomic mutation in the BRCA gene, they can take a specific pill that targets the tumor. These drugs are called PARP inhibitors. Patients with breast and pancreatic cancer also respond well to PARP inhibitors.

“When patients with BRCA mutations receive targeted therapy, they do better and have more therapeutic options,” said Dr. Kozma. “That’s why it’s so beneficial to know if patients have that mutation or not.”

The Cleveland Clinic Robert and Carol Weissman Cancer Center also offer patients the option to enroll in certain clinical trials to study other aspects of the disease. There are 18 clinical trials currently underway at Cleveland Clinic Martin Health, and more than 60 clinical trials at Cleveland Clinic Florida at Weston. The two centers often share resources, according to Dr. Kozma, as they continue to build up the research program in Martin County.

In the next five to 10 years, Dr. Kozma expects to see even more progress made in screening early-stage cancers, including the use of circulating tumor DNA (CTDNA).

“We know that in the early-stage cancers, we can detect tiny pieces of tumor DNA in peripheral blood,” she explained. “In the future, we may be able to do blood tests that detect that circulating DNA and screen for cancers, like ovarian and pancreatic cancers, that are unfortunately often found at stage 3 or 4.

“It also enables us to follow patients after treatment as well,” she added. “After a patient with colon cancer completes adjutant chemotherapy, for example, we can test their CTDNA through a blood test to see if the cancer has come back.”

For more information, visit www.clevelandclinicflorida.org.