Free cancer tumour genetic screening? That's the unusual offer from Contextual Genomics, a private company in Vancouver.
Starting this month, the first 1,500 Canadians who get their oncologists to send in their tumour samples will have their cancer tested using the the company's trademarked Find-It Cancer Hotspot Panel at no charge.
After that, the test will be offered for sale for less than $1,000.
"You could call it marketing, but it's making this test available to people who haven't had access to it before," said Contextual Genomics CEO Chris Wagner.
The idea is that there might be a drug out there that can target the particular cancer mutation. But that's if a drug exists, and if it's approved for use, and if the oncologist knows what to do.
'It's a shrewd and strategic business move to create an appetite for something that sounds wonderful. But whether it can deliver is still something that has to be established worldwide.' - Dr. Daniel Rayson, oncologist, Nova Scotia Health Authority
The unusual offer has raised eyebrows among some in the cancer research community.
"My concern is that offering them for free sounds fantastic. Who wouldn't want it?" said Dr. Daniel Rayson, interim head of medical oncology at the Nova Scotia Health Authority.
"It's a shrewd and strategic business move to create an appetite for something that sounds wonderful. But whether it can deliver is still something that has to be established worldwide."
Contextual Genomics is making it clear this is not a research project. Rather, the company has partnered with several pharmaceutical companies, including Sanofi, AstraZeneca and Pfizer, to make the test available to oncologists all over the country.
The test scans biopsy samples for genetic markers unique to an individual tumour, looking for 90 different mutations in almost 30 genes.
In theory, those genetic markers can act as targets for specific drugs. That is, if there is a drug.
"We can find mutations but there aren't actual drugs that can target most of those mutations," said Suzanne Kamel-Reid, head of laboratory genetics at Princess Margaret Hospital in Toronto.
"So at the end of the day when you try to match drugs to targets, really only five per cent of the current targets are druggable. And it's really only because of the lack of drugs out there."
At the BC Cancer Centre, the Personalized Onco-Genomics (POG) clinical trial is looking for genetic markers in a wide range of cancers, trying to match those mutations with particular therapies.
Dr. Janessa Laskin is leading that research. She says there is a concern that, outside of a research setting, large tumour gene screens could give patients and doctors information they can't use.
"It may not be clinically relevant even to the majority of patients, I don't think we know enough yet," she said.
Finding markers could create 'unrealistic picture'
"Just finding the marker doesn't mean the drug actually works for the patient," said Dr. Rayson. "It creates an unrealistic picture."
Most of the known tumour target therapies involve very expensive medicines that are not immediately available, and there's very little data that supports their use, he said.
Sometimes the genetic test can reveal a target for a drug that has not been approved to treat that type of cancer.
"If that treatment is off-label we may have trouble with drug access," said Dr. Laskin. "And some clinicians might not feel comfortable doing something so experimental outside of a clinical trial setting."
But the arrival of the commercial test is evidence that personalized medicine has hit the Canadian marketplace, regardless of whether the health-care system is ready for it.
"There is always a push and pull between new innovation and the system's willingness to adopt this, and it's particularly true in medicine," Contextual Genomics' Chris Wagner said.
"We''ve gone from zero to where we are now in probably under 10 years. And we've made an incredible amount of progress, so it is moving more quickly than most innovations happen," Wagner said.
"But it's not moving inappropriately fast. These are treatments and diagnostics that benefit patients today. And patients should have access to it," he said.
Currently, patients do have access to cancer tumour genetic testing for a small number of specific cancer markers, in breast, and lung cancer, for example. And some patients are having tumour screening as part of a clinical trial.
'You don't want to raise false hope'
At Princess Margaret Hospital, Suzanne Kamel-Reid says there's a risk of hype when discussing the benefits of cancer tumour gene testing.
"You don't want to raise false hope, and I think it's really important to make sure the right patient population is tested," she said.
"So you don't want the marketing to go out there and for patients to be feeling like they're missing out on something, or they're not getting the right treatment because they're not getting this testing. Because it may not be appropriate for them."
Contextual Genomics says it will be up to individual oncologists to decide if their patient will benefit from the test.
And when the free tests run out, the company says it is already talking to some health jurisdictions about paying to cover the cost.