It was the lofty goal of helping cancer patients and oncologists make the best treatment decisions possible by providing them with as much information as possible about their specific tumors that spurred the founding of a company called Foundation Medicine in April 2010. The company's founders — researchers Eric Lander, Todd Golub, Matthew Meyerson, and Levi Garraway, and biotech entrepreneur Alexis Borisy — are aiming to "translate what's becoming possible in cancer genomics into something that will be useful in the day-in, day-out, clinical, real-world practice of oncology," Borisy, also the company's CEO, says. Currently, the company is developing a test to measure mutations housed in tumors.
Initiatives like The Cancer Genome Atlas and the International Cancer Genome Consortium are "transforming" our understanding of cancer, Borisy says. During the next few years, he expects that more than 50,000 cancer genomes will have been sequenced — several thousand of each major type of cancer — and that information will bring with it knowledge about what kinds of mutations and molecular aberrations exist in each tumor, the frequency of those mutations, and which ones are relevant for treating the patient.
In order to help doctors capitalize on the flow of information, Foundation Medicine is developing a test that oncologists can use to measure their specific patients' tumoral aberrations and mutations in order to "optimize therapy selection for that patient and that patient's specific tumor," Borisy says. "Today, before you have surgery or radiation, you're going to have a CAT scan or MRI to physically image where the tumor is, and you would not consider getting radiation without that image so you would know where to focus the radiation beam. We believe that over the next five to 10 years, it will become standard-of-practice that you will do a comprehensive genomic test like what Foundation Medicine is creating for a cancer patient, that you need to know what has gone wrong with the programming code of that specific tumor to be able to consider how to treat that." While oncologists today can order a few gene tests, many of the important mutations and aberrations occur rarely, or under very specific circumstances.
For this test, the clinician would collect a sample of the patient's tumor and send it to Foundation Medicine's lab to be tested, Borisy says. "When research centers talk about sequencing cancer genomes, they talk about getting a nice large fresh piece of tumor," he says. "The reality is that to have something that works well in day-in, day-out clinical practice — this means very small pieces of tumor, something from a core biopsy or a fine-needle aspiration, or an FFPE slide." Once the doctor sends a sample to Foundation Medicine's lab, a reports is generated of the mutations and other aberrations present in the tumor. Along with the results, the clinician receives a report that puts those results into context of what's known in the clinical literature. "We're not trying to make the decisions for the oncologist, but we are a decision support tool," Borisy says.
As for the data Foundation Medicine collects from running such patient tests, Borisy says it "can become an enormously powerful recursive learning system that can be tremendously beneficial to the whole oncology ecosystem." The company is also exploring options of getting involved in collaborations with academia that would let patients opt into having the information from their tumors used to further knowledge about cancer genomics.