Our genetic counselors work as members of oncology health care teams by providing information and support to individuals who have cancer and their health care providers. Genetic counselors:

• Assess the risk of cancer by researching the family history and evaluating medical records.
• Weigh the medical, social and ethical decisions that can surround genetic testing.
• Provide expertise, support, and information to help a person make a decision about testing.
• Interpret and analyze the results of genetic tests and medical data.
• Provide counseling or refer individuals and families to support services.
• Serve as patient advocates.
• Explain possible treatments or preventive measures.

Cancer or tumor profiling – genetic testing of cancer or tumor DNA to identify the specific genetic makeup of the cancer.

Personalized medicine, also termed precision medicine, is a medical procedure or treatment that separates patients based on their individual predicted response or risk of disease.  In the case of cancer, personalized medicine applies treatments based on the individual patient’s cancer profile or biomarkers.

It depends on the medical history, current treatment plan and diagnosis of the patient.  For example, we may recommend somatic testing, including large panel testing that specifically looks for clinically actionable genes within the cancer DNA.  These tests may include a liquid biopsy, tumor tissue sequencing, companion diagnostics or complementary diagnostics.  Or if there is a history of cancer in the patients family we may recommend germline testing for risk assessment and preventative care. The lab testing space has grown drastically and there are a number of testing options available.  We will help navigate through the testing options based on the patient’s needs.

Some of these tests look at one specific marker and others can look at several hundred of them.  After analysis, the test may tell us if any of these markers are clinically relevant and if there are potential targeted therapies, including immunotherapies, and clinical trials with therapies available to target those markers.  These tests might also determine which treatments might not be good candidates for therapy. This is essentially the foundation for personalizing medicine, to identify a treatment plan based on the individual patient’s disease with predictive treatments. Our goal is to use genetic tests to identify treatments that could improve clinical outcomes for patients.  In some cases, genetic tests don’t identify clinically relevant or actionable results.  In addition some test results will identify if a patient is a carrier of a cancer causing mutation that could increase the patient’s risk of getting cancer.

Telemedicine is the use of telecommunication and information technology to provide clinical health care remotely. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities. MyOncoPath can support patients and health care providers across the US while adding the convenience of giving consults over the phone. For more details on the benefits of telemedicine click here.

You can ask your health care provider or they may refer you to a genetic counselor that specializes in oncology.  Since personalized medicine is new and not a standard of care, it is also important to do research for yourself and/or get a second opinion.  We also support patients directly and we will report our recommendations or results to the patient’s treating doctor as well as to the patient in a follow up consult.  You may also choose to see a genetic counselor if there is a history of cancer that may run in the family.

In many cases, healthcare insurance pays for genetic testing when it is recommended by a genetic counselor and or a doctor. However, before having any genetic tests, it is important to check with your insurance company to verify coverage. Different companies have different policies. Some cover certain tests but not others. As with most healthcare services, you may need to pay for some of the cost or a copay. The MyOncoPath genetic counseling services can also be covered by insurers. We recommend checking with your insurance provider to see if they will cover the costs or a portion of the costs. Our consults can generally range anywhere from $199 – $399.  The pricing depends on the complexity and the time spent on each case. Please contact us if you are interested in our services and testing even if you are concerned about the potential costs.

You can have genetic testing without speaking with a genetic counselor. Your doctor can order tests and provide you with the results. However, because a doctor may not be an expert in genetics, you may receive results that you don’t understand and you may have additional questions that leave you with questions unanswered. Genetic counselors have advanced training in medical genetics and counseling to interpret tests, and guide and support you as you seek more information about how cancer genetics might affect you or your family.

We are set up to work with most health care providers and doctors.  We believe your healthcare is a team effort. We work with the patient and the provider to deliver the best quality of care.  Since we can consult patients over the phone we can easily host a discussion with the patient and their doctor.  More commonly, we share test results and write up a summary of our findings for the patient and their provider.

Almost all cancer types can benefit from genetic testing.  In general, testing can be critical in phase III and IV cancers or when treatment decisions become less obvious.  There are targeted therapies available for most cancer types and as possible alternatives to chemotherapy or some chemotherapies.  There are also a number of clinical trials that aim to expand some of these therapies to other cancer types, or in combination with other therapies.  It is important to consider the genetic profile of the cancer as well as the cancer type for treatment consideration. *Here is a list of some common cancer types with known targeted therapies available.

• Microsatellite instability-high or mismatch repair (MSI/MMR)-deficient solid tumors: ***Pembrolizumab (Keytruda®)*** This Immunotherapy was recently approved for all tumor types. MyOncoPath is partnered with testing labs that provide this testing.
• Adenocarcinoma of the stomach or gastroesophageal junction– Trastuzumab (Herceptin®), ramucirumab (Cyramza®)
• Bladder cancer– Atezolizumab (Tecentriq™), nivolumab (Opdivo®), durvalumab (Imfinzi™), avelumab (Bavencio®), pembrolizumab (Keytruda®)
• Brain cancer– Bevacizumab (Avastin®), everolimus (Afinitor®)
• Breast cancer– Everolimus (Afinitor®), tamoxifen (Nolvadex), toremifene (Fareston®), Trastuzumab (Herceptin®), fulvestrant (Faslodex®), anastrozole (Arimidex®), exemestane (Aromasin®), lapatinib (Tykerb®), letrozole (Femara®), pertuzumab (Perjeta®), ado-trastuzumab emtansine (Kadcyla®), palbociclib (Ibrance®), ribociclib (Kisqali®)
• Cervical cancer– Bevacizumab (Avastin®)
• Colorectal cancer– Cetuximab (Erbitux®), panitumumab (Vectibix®), bevacizumab (Avastin®), ziv-aflibercept (Zaltrap®), regorafenib (Stivarga®), ramucirumab (Cyramza®)
• Dermatofibrosarcoma protuberans– Imatinib mesylate (Gleevec®)
• Endocrine/neuroendocrine tumors– Lanreotide acetate (Somatuline® Depot), avelumab (Bavencio®)
• Head and neck cancer– Cetuximab (Erbitux®), pembrolizumab (Keytruda®), nivolumab (Opdivo®)
• Gastrointestinal stromal tumor– Imatinib mesylate (Gleevec®), sunitinib (Sutent®), regorafenib (Stivarga®)
• Giant cell tumor of the bone– Denosumab (Xgeva®)
• Kidney cancer– Bevacizumab (Avastin®), sorafenib (Nexavar®), sunitinib (Sutent®), pazopanib (Votrient®), temsirolimus (Torisel®), everolimus (Afinitor®), axitinib (Inlyta®), nivolumab (Opdivo®), cabozantinib (Cabometyx™), lenvatinib mesylate (Lenvima®)
• Leukemia– Tretinoin (Vesanoid®), imatinib mesylate (Gleevec®), dasatinib (Sprycel®), nilotinib (Tasigna®), bosutinib (Bosulif®), rituximab (Rituxan®), alemtuzumab (Campath®), ofatumumab (Arzerra®), obinutuzumab (Gazyva®), ibrutinib (Imbruvica®), idelalisib (Zydelig®), blinatumomab (Blincyto®), venetoclax (Venclexta™), ponatinib hydrochloride (Iclusig®), midostaurin (Rydapt®)
• Liver cancer– Sorafenib (Nexavar®), regorafenib (Stivarga®)
• Lung cancer– Bevacizumab (Avastin®), crizotinib (Xalkori®), erlotinib (Tarceva®), gefitinib (Iressa®), afatinib dimaleate (Gilotrif®), ceritinib (LDK378/Zykadia™), ramucirumab (Cyramza®), nivolumab (Opdivo®), pembrolizumab (Keytruda®), osimertinib (Tagrisso™), necitumumab (Portrazza™), alectinib (Alecensa®), atezolizumab (Tecentriq™), brigatinib (Alunbrig™)
• Lymphoma– Ibritumomab tiuxetan (Zevalin®), denileukin diftitox (Ontak®), brentuximab vedotin (Adcetris®), rituximab (Rituxan®), vorinostat (Zolinza®), romidepsin (Istodax®), bexarotene (Targretin®), bortezomib (Velcade®), pralatrexate (Folotyn®), ibrutinib (Imbruvica®), siltuximab (Sylvant®), idelalisib (Zydelig®), belinostat (Beleodaq®), obinutuzumab (Gazyva®), nivolumab (Opdivo®), pembrolizumab (Keytruda®)
• Multiple myeloma– Bortezomib (Velcade®), carfilzomib (Kyprolis®), panobinostat (Farydak®), daratumumab (Darzalex™), ixazomib citrate (Ninlaro®), elotuzumab (Empliciti™)
• Myelodysplastic/myeloproliferative disorders– Imatinib mesylate (Gleevec®), ruxolitinib phosphate (Jakafi®)
• Neuroblastoma– Dinutuximab (Unituxin™)
• Ovarian epithelial/fallopian tube/primary peritoneal cancers– Bevacizumab (Avastin®), olaparib (Lynparza™), rucaparib camsylate (Rubraca™), niraparib tosylate monohydrate (Zejula™)
• Pancreatic cancer– Erlotinib (Tarceva®), everolimus (Afinitor®), sunitinib (Sutent®)
• Prostate cancer– Cabazitaxel (Jevtana®), enzalutamide (Xtandi®), abiraterone acetate (Zytiga®), radium 223 dichloride (Xofigo®)
• Skin cancer– Vismodegib (Erivedge®), sonidegib (Odomzo®), ipilimumab (Yervoy®), vemurafenib (Zelboraf®), trametinib (Mekinist®), dabrafenib (Tafinlar®), pembrolizumab (Keytruda®), nivolumab (Opdivo®), cobimetinib (Cotellic™), alitretinoin (Panretin®), avelumab (Bavencio®)
• Soft tissue sarcoma– Pazopanib (Votrient®), olaratumab (Lartruvo™), alitretinoin (Panretin®)
• Systemic mastocytosis– Imatinib mesylate (Gleevec®), midostaurin (Rydapt®)
• Thyroid cancer– Cabozantinib (Cometriq®), vandetanib (Caprelsa®), sorafenib (Nexavar®), lenvatinib mesylate (Lenvima®)

*Source NCI Targeted Cancer Therapies Fact Sheet