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START cancer center unveils new division
September 24, 2010

San Antonio Business Journal - by W. Scott Bailey

The START Center for Cancer Care has created a new division, GenomeConsult, that will link oncologists with patient-specific, DNA-based molecular testing to help advance more precise treatments for individuals suffering with cancerous diseases. START officials say this is a landmark development that will change the way doctors and researchers fight cancer, while raising the profile of the local center and the city - nationally and internationally.

"This is a really big deal," says Dr. Anthony Tolcher, director of clinical research for START, referring to GenomeConsult. "It's a big deal because cancer is a genetic disease."

Health care and the biosciences combined are a multibillion-dollar industry in San Antonio - the city's leading economic driver. Tolcher says San Antonio is poised to grow that industry, and the creation of GenomeConsult is a step in that direction.

"This approach is a big step forward and will provide doctors with more information to rationally direct therapy," says START Center President Dr. Lon Smith.

Dr. Shelly Gunn is heading up START's GenomeConsult effort. "These newly-developed clinical tests can help predict tumor behavior as well as response to therapy by analyzing the tumor at its origin, which is DNA," Gunn explains.

"We are fortunate to have many visionary oncologists (at START) who recognize that we will not win the war on cancer unless we understand each patient's disease at the genomic level," she adds.

The START Center's GenomeConsult will be operated in a partnership with CombiMatrix Diagnostics - a clinical laboratory based in Irvine, Calif. It is a wholly owned subsidiary of CombiMatrix Corp., a biotechnology company headquartered near Seattle.

START is a San Antonio-based cancer center comprised of a team of more than two-dozen internationally recognized oncologists. It operates one of the world's largest Phase I clinical trials programs for oncology and has research facilities in Madrid, Spain.

More appropriate therapy

One of GenomeConsult's chief tasks will be to obtain tumor tissue either through a new biopsy handled by interventional radiology at the START Center, located in the South Texas Medical Center, or by securing blocks or slides from the pathologists who stored the tissue after a surgical or biopsy procedure.

The anatomic pathology team at CombiMatrix Diagnostics will then identify the tumor area and perform a targeted DNA extraction followed by a genomic profiling study, which takes about a week. Then GenomeConsult will interpret that data, prepare a report and discuss the findings with the cancer patient's oncologist.

Tolcher says the patient could then enroll in a clinical trial at the START Center or receive treatment elsewhere.

"So much of what we've done - both experimentally and with conventional chemotherapy - is to treat the average patient," says Tolcher. "Yet each person's cancer is very individual.

"Now, at last, we can start to take patients who have genetic abnormalities, (where) conventional treatment has failed them and who are looking for other options and we can profile their genome," Tolcher adds. "Now, those patients can be offered more appropriate clinical trials, more appropriate therapy."

It has been less than a decade, Tolcher explains, since the Human Genome Project was completed. The HGP was a coordinated effort involving multiple players, including the U.S. Department of Energy and the National Institutes of Health. One of the primary goals of the project was to identify all of the genes in human DNA.

Tolcher says some have been unfairly critical of that effort, arguing that there have been too few tangible results from the lengthy project.

"The real value is going to be understanding diseases like cancer, which are diseases that are associated with altered genes," Tolcher says.

Game changer

"Genomic profiling confirms that the effort expended in the Human Genome Sequencing Project is beginning to bear fruit," Smith contends. "Armed with information about the molecular machinery driving each individual tumor, we will have a new direction for treating resistant malignancies."

Gunn agrees. "Being among the first clinical oncology groups to offer comprehensive tumor genome profiling is extremely significant," she says.

"I hope our endeavor sends a message to the rest of the world that the Human Genome Project was a tremendous success in that it gave community oncologists and pathologists a high-quality reference genome to which we can compare our patient's abnormal tumor genomes," Gunn adds. "With this knowledge, we can better predict disease outcome and plan treatment using the same biotechnology tools that were developed for the genome project."

The creation of GenomeConsult likely won't bump up the size of START's employment ranks significantly. But it could boost the center's bottom line.

Gunn says START has projected that GenomeConsult will eventually analyze some 5,000 tumor genomes annually. It's unclear at present what that will mean in terms of total revenues.

But START's decision to create the GenomeConsult division was timely. Recent advances in genomics, proteomics, molecular imaging and other new technologies are leading to a molecularly based reclassification of cancer, American Association for Cancer Research officials say.

Dr. Frankie Ann Holmes is a clinical researcher who worked at Houston's M.D. Anderson Cancer Center for 15 years and is now co-director of the Breast Cancer Research Program of US Oncology Research.

"What START in San Antonio is offering is a unique and valuable molecular tool," says Holmes about GenomeConsult. "This (new) intel is a game-changer."

START's Smith says San Antonio has built a national reputation as a leader in cancer research. "It is here that molecular profiling began to develop in a clinically useful way with the estrogen receptor and later the identification of the HER-2-neu receptor," he says. "The genomic profiling further builds on this legacy."

Says Tolcher, "What you want is innovation. The real test of success is being the most innovative, meeting the unmet need."

He says the creation of GenomeConsult was a "pretty substantial" move for START and, ultimately, for San Antonio.

"The fact that we are making this leap early, investing our time, energy and money to do this ... will (allow) us to be in the forefront," Tolcher adds. "There is no reason that, with the right amount of hard work, we couldn't develop San Antonio into a core (region) for molecular genetics."

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