Clinical Genomics

Platform May 1, 2013

Joyceann Musel-Winn, MS, MT (ASCP)

Division Administrator

Division of Pathology and Laboratory Medicine

The University of Texas MD Anderson Cancer Center

• Making Cancer History

• Testing Patterns

• Pathologists Role

• Reimbursement

Clinical Genomics Platform

Moon Shot Strategies

• Acute myeloid leukemia and myelodysplastic

syndrome

• Chronic lymphocytic leukemia

• Lung Cancer

• Melanoma

• Prostate cancer

• Women’s cancers: breast and ovarian

Ion Proton

Ion Torrent

Challenges

• Front door consent • Germ line controls– secondary research findings

• Discoverable mutations affecting family members

• Sample collection- quantity and quality • Interventional radiology

• Micro dissections

• Analyzers vary in quantity requirements

• Dynamic nature of the analytics • Expensive and getting faster, smaller and cheaper

• DNA, RNA, CTC, Free DNA, proteins

• Informatics- Amount of data!

Oliver as a Role Model ….

Please sir, … may I have another

Petabyte of Storage??

Challenges Continued

• Informatics • Software and pathologist time to interpret

• Integration of all CG testing • Collaborate with Medical Oncologist

• Collaborate with Physician Scientists

• Storage • Searchable data for future review and comparisons

• Specimens, several types (frozen tissue, FFPE, serum, RNA, patient controls)

• Robotic Freezers

• Reimbursement panels vs. single CG test

Pathologists Role

• Recognized authority for Clinical Genomic testing

• Work with IR physicians to assess the biopsy sample POC,

including evaluating cellularity

• After reviewing and interpreting the tissue, marks slide to best

capture the tumor for the DNA extraction

• Interpret sequencing data for gene mutations

• Review patient clinical history and literature to correlate with

findings and possible contraindications to targeted therapy

• Collaborate with the Medical Oncologists for best treatment,

diagnosis and prognosis.

• Reimbursement- pathologists provide clinical vignettes to

support medical necessity

Integrated Clinical Care Model

Pathologist

Medical Oncologist

IR/Surgeons

Research Environment

Clinical Genomics Laboratory

January 2015

Questions?