IT’S ALL IN OUR GENES

GENOMIC TESTING IS a crucial tool in our efforts to understand cancer better. It enables us to identify genetic changes in individual cancers, which means we can offer improved, personalised treatments to our patients. Inherited genetic changes, for example, are passed down to a person from one of their parents, giving them an increased risk of developing certain cancers. For people who already have cancer, their genes can also determine how the disease will behave and which treatment they will respond to best.

At The Royal Marsden, this work is led by our Cancer Genetics Unit, which aims to promote cancer prevention and early detection, and help with decisions about managing the disease. Our expert consultants and genetic counsellors assess a patient’s personal and family history of cancer to decide whether it is likely that there is a hereditary cause. This assessment is used to decide whether a genetic test might help an individual to clarify their own risk or make recommendations about additional screening.

Genomics also includes somatic testing, which looks for changes in the genes of existing cancer cells. The results can then be used to plan treatment, including the use of targeted personalised therapy and immunotherapy. This takes place in the National Institute for Health and Care Research (NIHR) Centre for Molecular Pathology (CMP) in Sutton, which houses researchers from The Royal Marsden and The Institute of Cancer Research, London (ICR).

A PATIENT’S PERSPECTIVE

Jennette Higgs, 61, breast cancer patient

“I was diagnosed with breast cancer 10 years ago. Following treatment, I joined the BOCS gene-testing study at The Royal Marsden and discovered I had the BRCA2 gene mutation.

“These results meant my family were eligible to be tested, too. My sister and I have now had further reconstructive surgery to reduce our risk of getting breast cancer again in the future. “Knowing we have the gene has made such a difference to me and my family. It also means my sons will be monitored for prostate cancer, as the BRCA2 mutation means their risk of getting the disease is higher.”

Calculating risk

Dr Angela George, Consultant Medical Oncologist and Consultant in Oncogenetics, leads The Royal Marsden’s teams across both areas. She is also Clinical Director of Genomics – in a joint role alongside Professor Michael Hubank – and undertakes testing for inherited cancer syndromes in her oncogenetics practice.

“For each different cancer type, there are specific criteria as to who is offered testing to identify whether they have an inherited cancer gene,” Dr George says. “These include any woman under 40 with breast cancer and patients with bowel cancer who have changes in their tumour that may indicate an inherited alteration. Women with ovarian cancer are offered testing for the BRCA gene alteration.

“Somatic testing for solid tumours and blood cancers is now delivered through a national testing network of seven Genomic Laboratory Hubs [GLHs]. The Royal Marsden is part of the North Thames GLH.”

Test for success

As Clinical Lead for the Cancer Genetics Unit and a Consultant

Medical Oncologist in the Breast Unit, Dr Zoe Kemp is passionate about increasing access to genetic testing in breast cancer patients.

“The best part of my job is where my roles intersect, enabling me to use patients’ genetic information to inform their treatment choices and prevent new cancers,” she says.

“I also delivered the Mainstreaming Cancer Genetics programme in the Breast Unit, where non-genetic clinicians were trained to ask patients’ consent for genetic testing in surgical and oncological clinics.”

Consultant Clinical Geneticist Dr Terri McVeigh takes care of Royal Marsden patients who have a suspected or confirmed hereditary predisposition to cancer, as well as looking after their at-risk relatives.

“My role is always evolving, as genomic profiling becomes broader and more readily accessible,” she says. “I am more likely to care for patients who have already received results from genetic testing, but these can be complex, and we need to decide the next steps to take.

“The rarity of some disorders and inherent complexity of genomic results means that collaboration with colleagues is essential. It’s a privilege to work with, and learn from, expert colleagues working across a variety of tumour types.”

A molecular level

Thanks to the transformative impact of genomics, cancers are increasingly treated due to their genetic changes.

“When looking for molecular or genetic changes, we’re looking for what drives the cancer to grow and spread,” says Dr George. “And if you can turn that driver off, that’s the most effective way to treat that specific cancer. The real benefit is that you can make sure patients are getting the treatment that is most likely to work for them.”

The prospect of personalising treatment is why Professor Hubank, Director of Clinical Genomics (Research) at The Royal Marsden and Scientific Director of the NHS