Jaclyn A Biegel, PhD, FACMG, the Division Chief of Genomic Medicine and the Director of the Center for Personalized Medicine in the Department of Pathology and Lab Medicine at Children’s Hospital Los Angeles, talks about a new targeted sequencing panel for children with cancer.
Tell me what OncoKids is?
Dr. Biegel: OncoKids is a targeted, next generation sequencing panel that includes DNA and RNA content. It’s applicable to children with all types of cancer – leukemia, brain tumors, and solid tumors.
What does it do?
Dr. Biegel: We use that test to help make a diagnosis for patients, determine prognosis and potentially identify therapies like Michelle’s.
And how does it differ from what you would use before?
Dr. Biegel: It’s more comprehensive. The assay was based on an adult-focused panel, which we adopted and then greatly expanded for pediatric cancer. Pediatric tumors are not like adult cancers. The diagnosis of adult cancers is primarily based on the organ where it develops; breast cancer, prostate cancer, lung cancer … The types of tumors children get are different.
So how are children different? That was adults right?
Dr. Biegel: In children, the same tumors can arise in different parts of the body, and they’re diagnosed based on what the cells look like and what the genetic alterations are. That’s true in adults as well, but the most common tumors in adults – breast cancer, prostate cancer, lung cancer, colon cancer – are carcinomas, and those are rare in children. The drugs that you need to use to treat them are therefore different. Children are not just little adults; they actually have different types of cancer. They can withstand a lot more chemotherapy than adults can. They respond better to bone marrow transplant, they recover sooner. But they will also liver longer and we worry about long-term side effects. You have to take the whole child into consideration. Where the tumor is located – can you remove it by surgery? If you need to use radiation, try not to treat all of a child’s growing brain because you’ll have subsequent morbidity associated with that. There are a lot of things that we take into account for children that are not necessarily highest on the priority list for adults.
So you really, really need highly personalized medicine for children.
Dr. Biegel: Precise medicine is key for children. We distinguish precision medicine from personalized medicine here at CHLA. We’ve always optimized treatment and care on a personal basis for children. From a laboratory perspective, when I think about “precise”, that has a different meaning for me. Personalized means that we’re using the right tests for the right patient. That’s my motto for the Center for Personalize Medicine. That can range from single gene testing to a comprehensive panel like OncoKids. But we want to make sure that we’re using the best test that we can, which depends on what tumor the child’s presented with.
Now is OncoKids the only kind of test like it?
Dr. Biegel: OncoKids is unique because it’s comprehensive, using both DNA and RNA, the different parts of the cells that are coding for your genes and making the genes that will ultimately become proteins; those are the workhorses of your cells. Again, it’s comprehensive for all types of tumors. A lot of other panels have been developed specifically for leukemia or for prostate cancer.
Can you talk about all the different people that had to come together to help Michelle or the different teams?
Dr. Biegel: The advantage of being treated at a hospital like Children’s Hospital Los Angeles and having the ability to pull together a multidisciplinary team – radiology, oncology, pharmacy, the laboratory effort, pathology – is that everybody is working together to put all the pieces together to make sure you have the right diagnosis, the right treatment, and the ability to treat the patients appropriately, support that care, and then follow her as she’s being treated and hopefully goes on to live a wonderful life.
END OF INTERVIEW
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