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For those who have been diagnosed with cancer, you know the shock and fear that runs through your soul. Thousands of people hear those words every day. I am here to tell you that while there are no bright sides to a cancer diagnosis, there is hope right here in our home community.

Recently, a friend of mine got the chance to spend time with Dr. Joe Stephenson and Savannah Hightower, AGAC-NP at St. Luke’s Cancer & Infusion Center, and asked them, “What’s new in the world of cancer treatment?” That one question opened a dialogue that left my friend’s head spinning and their heart full of assurance. One would think a conversation about cancer would be depressing. One word best describes both Dr. Stephenson and Savannah — optimistic. 

What should really blow you away is that the things done at St. Luke’s Cancer and Infusion Center are what one might expect at MD Anderson, Sloan Kettering or the Mayo Clinic. 

When asked about the differences between Dr. Stephenson’s treatment protocols and those of his peers, the good doctor replied, “The available treatments we all have are essentially the same, but the delivery may differ. At St. Luke’s, we’ve strongly embraced preventative strategies, molecular profiling through genetic, genomic, and germline testing, and the promise offered through immunotherapy. While targeted therapy, chemotherapy, and radiation remain in our treatment arsenal, we’ve only scratched the surface of the potential for immunotherapy and CAR-T TIL therapy (chimeric antigen receptor and tumor-infiltrating lymphocytes). Every day, we learn more about how and when to manipulate the human immune system. The key is the timing of therapy and knowing when to re-engage the body’s immune system.” 

The team tests nearly every patient for molecular drivers to create profile panels. Dr. Stephenson said, “The importance of molecular diagnostics is the roadmap for treatment it provides. Molecular diagnostics dictate how aggressively we treat.” In the past, prevailing protocols without these diagnostics could cause over-treating some cancers.

“Molecular profiling has ushered in a shift in our approach to cancer treatment,” said Dr. Stephenson. “We now personalize our therapies to address the considerable variants in each patient’s environment, genetics, and habits to deliver individualized precision medicine.”

Savannah Hightower said, “Through analyzing genomic data, we can distinguish different mutational signatures that contribute to cancer. These mutations are like ‘fingerprints’ that offer clues to the effectiveness of different therapies.”

Savannah orders molecular profiling on specimens with malignant diagnoses from a biopsy or surgery. The type of diagnosis determines the kind of panels produced. The most common profile is an 84-gene panel. Registered Nurse and Lung Cancer Screening Coordinator Lacy Rainey ensures the accuracy of information sent to the profiling laboratory. The profiling process takes fourteen to twenty-one days from start to finish. Once results are received, the patient returns to review them and begin treatment planning.

Genetic testing looks for single gene mutations and the effects that genes have on the body. It also looks for abnormalities you may have inherited from your parents. This test can confirm a diagnosis, predict future risk, and identify if you are a carrier. Genetic tests use blood samples, hair, skin, amniotic fluid, or other tissue samples. The genetic testing process is different from the above as it includes a detailed personal past medical history and family history. With this information, the team draw labs and orders the genetic testing. Results are received in seven to fourteen days.

Genetic tests may help identify a person’s cancer risk, but genomic testing helps identify the genetic markers on a malignant cell. 

Genomic Testing identifies the structure, function, mapping, and evolution of the complete set of DNA for all of our genes. It shows how our body works on a molecular level and predicts the aggressiveness of the cancer. Genomic testing can determine how a tumor will likely behave regarding treatment options. 

Genomic testing in cancer identifies tumor behavior, the aggressiveness of the tumor, the likelihood the tumor will metastasize and predicts tumor response to drug therapy. 

Germline Genetic Testing detects inherited DNA mutations in reproductive cells (egg or sperm) at conception. People with germline mutations are predisposed to diseases like ovarian cancer, breast cancer, Lynch Syndrome, or inherited high cholesterol. With these traits identified, Dr. Stephenson works with the patient to proactively treat or prevent disease onset or, in some cases, recommend additional screenings to monitor for abnormalities.

Somatic Germline Testing examines the DNA of specific cells in the body to identify any alteration in DNA that occurred after conception. These mutations do not pass from parent to child. In somatic testing, known cancer cells are tested. The findings of the test help determine the most beneficial course of treatment. Causes for somatic mutations include environmental exposures to tobacco use, ultraviolet light, viruses, chemical exposures, radiation, and aging.

This article is the first of a three-part series. The next column will discuss “Immunotherapy.” If you have questions about anything mentioned in this article, contact Savannah Hightower at (828) 894-0111 or visit StLukesNC.org/cancer.