Precision medicine testing allows for more precise cancer diagnoses

January 06, 2023
Jasmine Kamboj, MD

At Allina Health Cancer Institute (AHCI), we integrate precision medicine into our overall approach to patient cancer care, from diagnosis through treatment. This personalized approach analyzes a cancer’s exact genetic makeup. We can then prescribe targeted drug therapy for the patient that will combat those specific cancer genes.

In this post, we cover the use of genomic testing, or testing for the genotype of a specific cancer. We also address genetic testing to evaluate a patient’s genetic makeup.

How AHCI uses precision medicine tests to achieve precise cancer diagnoses

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A crucial first step in precision medicine is to ensure that a patient’s early diagnosis is as precise as possible. The initial diagnosis sets the patient’s future treatment pathway.

For accuracy, we review every new cancer diagnosis with at least two pathologists. These physicians have a subspecialty expertise, such as breast, colon or lung cancer.

Then we perform various genomic tests, which our oncologists use to determine a final diagnosis and treatment. We aim to present these recommendations to the patient during their first appointment at AHCI.

Our genomic testing includes the use of:

Biopsies

Adequate biopsies are an important part of precision medicine testing. We may order two types of biopsies:

  • Solid biopsies: Our pathologists work closely with the doctors who perform the tumor biopsies. With the initial biopsy, we strive to obtain a sufficient specimen size for all the needed studies. We carefully triage and preserve small samples in case they are needed for further analyses.
  • Liquid biopsies: We use a blood sample and run the same genomic tests that we completed on the solid tissue. We use a liquid biopsy if the solid biopsy was inadequate or if we want additional information. We also use liquid biopsies to assess for gene mutations that may have caused the cancer to become resistant to a drug therapy.

Minimal residual disease monitoring

We have the capability, including necessary collaborations with commercial vendors, to perform minimal residual disease monitoring on blood samples. We test the blood for fragments of tumor DNA, which can indicate a recurring cancer before it is even seen on imaging. Through this early detection, we know that the patient may need closer monitoring.

Standard of care testing

Based on a patient’s initial diagnosis, imaging and other clinical factors, we apply algorithms and test according to AHCI’s established clinical guidelines. For example, in lung cancer, we test based on the cancer stage and perform gene sequencing and/or PD-L1 testing, a marker for immunotherapy.

For sequencing, we run next-generation sequencing (NGS) for DNA and RNA samples. At AHCI, this targeted gene sequencing follows National Comprehensive Cancer Network (NCCN) guidelines and FDA drug treatment approvals for the particular tumor. Our in-house testing usually has a one-week turnaround. Then we carefully preserve the tissue for more comprehensive testing through reference laboratory partners if indicated. 

AHCI’s expertise in precision medical testing

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AHCI has a team of experts that supports our precision medical cancer testing. These resources include:

  • Pathologists: AHCI is supported by an independent group of 39 subspecialized pathologists. Many of our pathologists are nationally recognized leaders in academic and professional organizations.
  • Medical oncologists: AHCI is led by a group of highly trained medical oncologists and hematologists who come from institutions of national and international acclaim (such as MD Anderson Cancer Center in Houston). We have more than 15 medical oncologists who practice at Abbott Northwestern Hospital, United Hospital and Mercy Hospital. They also practice at regional clinics that support communities closer to their homes, like Buffalo Hospital, United Hospital-Hastings Regina Campus, Allina Health Faribault Medical Center and River Falls Clinic.
  • Other physicians: Many other specialties are involved in our precision medicine testing, including pulmonologists, thoracic surgeons, breast cancer surgeons and others.
  • Precision medicine tumor board. AHCI uses a hybrid model for its precision medicine tumor board. A group of medical oncologists, pathologists, geneticists, nurse navigators and national consultants meet to discuss challenging cases. They consider NCCN guidelines, FDA approved treatments, off-label treatments and potential clinical trials based on the patient’s NGS results.
  • Nurse navigators: AHCI’s nurse navigators coordinate patients’ care in the community. These oncology nurses communicate with pathologists and treating oncologists about the NGS results. They are the central coordinators of information between the patient and the entire treatment team.

We bring genomic testing closer to home

AHCI makes genomic testing for cancer easier for patients who live in suburban and rural communities.  We can order NGS on a previously obtained solid tumor specimen, a repeat biopsy, or a liquid biopsy from a blood sample. The patient can have their blood for the liquid biopsy drawn at regional clinics or at their home. Our standardized biopsy practices across various clinical specialties ensure quality and continuity of care across the system. These offerings promote equity and help patients be more comfortable by receiving care in their community without having to travel.

Genetic screening, testing and counseling for heritable cancers

Testing the genetic makeup of patients (germline testing) can also be valuable. AHCI currently offers:

  • Genetic screening and testing: We are often able to perform patient genetic screenings using a virtual consultation. If the patient is eligible for genetic testing, we ship them a kit to provide a sample (often a simple cheek swab), which they send back to us. Then we screen the sample for gene mutations or alterations.
  • Genetic counseling for heritable cancers: We provide genetic counseling at nine of our locations. The primary focus for this group is germline testing, which looks for hereditary gene mutations. We recommend this testing for patients who don't have cancer but are at high risk of developing it in the future because of their family cancer history and genetic makeup. We offer preventive medicines to help high-risk patients avoid developing cancer.

How AHCI works with referring providers

We openly communicate with all referring providers. Typically, you can reach our medical oncologists through a clinic nurse or nurse navigator, or directly via our EMR’s messaging system. We observe patient privacy and HIPAA laws whenever we share any patient information. AHCI’s oncologists can offer helpful guidance during any phase of a patient’s care, from an early diagnostic workup to later stage consultations.

For pathology-related questions, you can reach our pathologists directly via cell phone. If a pathologist cannot answer your specific question, they will find the answer for you. 

This approach to working with referring providers sets AHCI apart. Our medical oncologists and pathologists welcome your questions about patient diagnoses, management and genomic testing.

How to refer a patient to AHCI

We value the opportunity to work with referring physicians to provide genomic cancer testing or patient genetic testing.

  • Genetic (germline) testing: You can make a referral for patient genetic screening or testing directly to AHCI’s geneticists at 612-863-2520. These referrals do not need to go through our oncology department.
  • Genomic (somatic cancer) testing: For Allina Health Laboratory testing, you can order tests through our laboratory consult center by submitting a faxed add-on testing form and/or calling 612-863-4670 (option 2). For reference laboratory testing, you can order a wide variety of tests directly through the vendor, who will contact the consult center with the testing request.
  • Oncology appointments: Providers from outside Allina Health can refer patients by calling our nearest cancer center: