How Does This Process Work?
Once you have been invited to participate with the Inova Molecular Tumor Board, a sample of your tumor is taken for genetic testing. Once the findings are available, the board meets to discuss them and reach a consensus on a personalized treatment for you.
You and your family members are invited to meet with the panel when your case is discussed. This allows physicians, scientists and you the opportunity to work together to find an excellent treatment.
What Should I Expect at the Tumor Board Meeting?
A moderator presents a brief overview of your medical history, including the type of cancer you have and prior treatments, followed by the presentation of the results of the molecular analysis of your tumor. The panel, made up of geneticists, biochemists and clinicians, asks questions and makes suggestions and comments. Some of the participants attend in person while others call in.
At the end of the meeting, recommendations are made. Our administrative team will help implement the recommendations by assisting you in enrolling in a clinical trial (inside or outside of Inova), or by obtaining a targeted therapy from a previously held clinical trial. Clinical trials and the new medications that result from them are generally the newest treatment options available and are not yet readily available to physicians in practice.
While most of your questions can be answered after the meeting by your clinician, you are welcome to ask questions or add comments that you feel are important to the conversation. Please note that the discussion is about your molecular results and not about symptom management or other questions that are more appropriate for your doctor.
What Do You Mean by 'Molecular Characteristics' of a Cancer?
Cancer is a very complex process, and many factors drive its growth. The cells in our body normally divide and stop dividing in an orderly process, but this process is disrupted by cancer.
Each cell in our body has 23 pairs of chromosomes. These chromosomes consist of DNA, which makes us who we are. Often we can find a DNA mutation that is known to disrupt the normal process of cell division and cause or promote cancer. These DNA mutations are examples of the molecular characteristics of a cancer. Sometimes they are inherited and are found in all of one's cells. But more frequently they are "somatic" mutations that are not inherited.
Somatic mutations occur during cell division during one's lifetime and are only seen in cancer cells in your body. These make excellent targets for cancer therapy.
How Are the Mutations Found?
DNA sequencing is a process by which genes known to cause cancer are analyzed in tumor cells. A sample of the tumor is sent to our lab at Inova Translational Medicine Institute (ITMI) or an outside company. DNA will be extracted and then analyzed.
Sometimes no mutations are found, meaning the cancer may be driven by a mutation that has not yet been discovered. More often there will be at least one mutation seen.
Today we have the ability to analyze tumor DNA fairly quickly. That allows researchers and scientists in the field to more quickly design new medicines that target the characteristics of the tumor that promote growth.
Is DNA Sequencing the Only Means of Finding Molecular Characteristics of the Tumor?
DNA sequencing is the most widely available means of molecular analysis of tumors. It is currently the primary tool used by Inova Molecular Tumor Board. However there are numerous other kinds of analysis in development. Among others, these types of analysis include RNA analysis, the measurement of proteins relevant to cancer, known as proteomics, and phosphoprotein assays that interrogate intracellular pathways that lead to cancer progression.