In this story:

  • Comprehensive Genomic Profiling (CGP) is driving innovation across Providence's 51-hospital system.
  • Our philanthropic partners are helping us advance genomic science and imaging technology to diagnose cancer faster and treat it more effectively. 

Carlo Bifulco

In the future of cancer treatment, what if clinicians could provide answers quicker and deliver more effective care—on a routine basis? For Providence, that future is the present.

Dr. Carlo Bifulco is medical director of Providence Molecular Genomics Laboratory, which serves the entire Providence health system. With a growing team of pathologists and bioinformaticians on staff, the lab is emerging as one of America’s largest clinical genomics operations. Perhaps its biggest service is GenOmic cancer profiling, which uses next-generation Comprehensive Genomic Profiling (CGP) to assess hundreds of cancer biomarkers from numerous tumor types in a single test. “This can point patients toward targeted or immunotherapies that might not have been identified through single gene tests or panels,” says Dr. Bifulco.

Saving Time and Tissue

Dr. Bifulco’s team is also focused on testing turnaround time. To minimize costs with molecular testing, labs will often perform a single-gene or small panel test, wait for the first negative result, then go for a second round, and if that test is negative, go for a third round. This approach takes a minimum of three weeks, while CGP requires about half that time—which is critical when treating aggressive cancers.

CGP is also helpful when the biopsy sample is very small or the tumor is in an inaccessible location. “If you order sequential tests, you may end up never getting to the test you want because the tissue has been completely depleted in multiple attempts of making single gene tests. The end result is that even getting a result is impossible, or where there is no tissue leftover for the test which is needed. CGP prevents that kind of scenario completely,” says Dr. Bifulco.

“We make a difference every day and we see it at every level.” – Dr. Carlo Bifulco, medical director, Providence Molecular Genomics Laboratory

All Cancer Patients Benefit from Genomic Testing

Dr. Bifulco’s ideal scenario is to deliver GenOmic CGP testing to patients of all cancer diagnoses, independent of stage, as early as possible.

“These tests are traditionally ordered by the oncologist at a time when conventional therapies are not applicable anymore,” Dr. Bifulco explains. “They’re usually being done when people are metastatic or have advanced disease and chemo is basically no longer an option. At that stage, folks really seek out targeted therapies and personalized medicine approaches. Our intent is to offer CGP at the first sign of a tumor as soon as it is acknowledged by the pathologist. I think this approach will be a game changer for patient care.”

The Impact of Diagnostics

“We make a difference every day—at the level of therapy and of people being eligible for therapies that would have never been given to the patient. We also see an impact on the diagnostic process,” Dr. Bifulco explains, referencing scenarios where genomic findings corrected a prior diagnosis and completely altered the case.

He recalls several oncologists showing surprise and relief when this type of comprehensive testing reversed a bleak picture, but says we still need to expand recognition of the utility of testing. “I often feel testing is like a second-class citizen. We spend millions of dollars on therapies, but we are very cheap on the testing side, and I think we are putting the cart before the horse. Testing is really the driver,” he says.

"I see us standing at the precipice of a new era that we could hardly imagine 10 or 20 years ago. We’re looking forward to very exciting times ahead.” – Dr. Carlo Bifulco, medical director, Providence Molecular Genomics Laboratory

Philanthropy Powers Genomic Progress

Looking ahead, Dr. Bifulco wants to move beyond the current tumor-only approach, adding what he calls “layers on top of CGP.” Generous donations will make it possible to assess a tumor’s microenvironment, which requires work on image analysis and data integration that will let clinicians look at a tumor’s RNA layer and methylation layer and do whole-genome sequencing.

“Inevitably we’ll have a much deeper, more systematic integration of genomics into our workup of the patients, routinely applied all the time. Then as they go through therapies, we’ll do routine comprehensive monitoring of the patients through genomic tools such as liquid biopsies and do a proper analysis of the interactions. I think it would be cost-effective and could significantly impact outcomes. It’s only a matter of when.”

Support from our donors will also make it possible to use machine learning to recognize disease progression automatically and report it in real time on the electronic medical record (EMR) system. This would happen across very large cohorts of patients, with the system dynamically matching them with Providence’s GenOmic data sets—so any time a patient's disease progresses, they would know potentially what clinical trials could be applicable to the patient.

“With genomics we really have an opportunity to shift the scales in oncology and how we approach proactive, personalized patient care overall,” says Dr. Bifulco. “I see us standing at the precipice of a new era that we could hardly imagine 10 or 20 years ago. We’re looking forward to very exciting times ahead.”

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