By Clinical Informatics News Staff

February 16, 2016 | First results from the Intensive Trial of OMics in Cancer (ITOMIC) were published last month in the Journal of the National Comprehensive Cancer Network (J Natl Compr Canc Netw 2016;14:8-17). For the first published patient, 32 researchers from 14 institutions took part in evaluation.

Led by Anthony Blau at the University of Washington, the ITOMIC trial is intensive longitudinal monitoring of patients with triple-negative breast cancer. The goal is to consider how a distributed network of investigators could study a patient’s progress and make treatment suggestions.

The first participant had triple-negative breast cancer metastatic to bone, and markedly elevated circulating tumor cells (CTCs) that were monitored 48 times over 9 months. A total of 32 researchers from 14 institutions were engaged in the patient's evaluation. Whole exome sequencing was done on three bone marrow samples and the results shared with the team. Members of the evaluation team made medication recommendations based on the genomic findings, but the drugs were not available before the patient passed away.

Nevertheless, “focusing the expertise of a distributed network of investigators on an intensively monitored patient with cancer can generate high-resolution views of the natural history of cancer and suggest new opportunities for therapy,” the ITOMIC authors wrote.

It’s a vision of personalized medicine: one very sick patient with a cadre of experts reviewing progress and adjusting course.

“The distributed analysis of an individual patient with cancer with interventions aimed at generating therapeutic benefit coupled with monitoring of disease response, [establishes] a learning loop that may enable the development of more effective therapies,” the authors posited.

But for this approach to work, the infrastructure supporting it must be robust. ITOMIC chose DNAnexus to support the network.

DNAnexus’ platform has enjoyed its share of deployments recently. The company won the contract to create PrecisionFDA, set records with the CHARGE study, a large heart and aging study run by Baylor College of Medicine, and globally supports Natera, a noninvasive prenatal testing company.

“The idea that all [of medicine] has to be done by one person in one place is not the way science goes,” says DNAnexus’ David Shaywitz. “The people—and everything—are really distributed. So how do you leverage distributed intelligence in a way that aligns with discovery and ultimately leads to what’s in the best interest of the patient?”

Shaywitz’s answer, of course, is the cloud. Like DNAnexus’ other platforms, the network for the ITOMIC study was set up via Amazon Web Services. DNAnexus is “theoretically cloud-agnostic”, Shaywitz says, but he says the company hasn’t had any clients express interest in other cloud providers.

“Amazon has a very strong infrastructure and we run on top of Amazon with a range of other features that ensure appropriate security and compliance,” Shaywitz says.  

While a study like the ITOMIC trial seems promising for extreme cases, is applying the expertise of 32 researchers from 14 institutions to one patient’s case scalable? Could that really be a vision of the future of personalized and genomic medicine?

In short, Shaywitz says yes.

While keeping a ratio of 32 researchers for every patient, “would be very hard,” Shaywitz says, “What I do think is scalable is the idea of bringing to bear different expertise, difference capabilities seamlessly for the care of the single patient without having everyone be in the same lab, in the same institution, in the same site. It’s entirely reasonable.”

Natera’s testing even happens, “in clinical time,” he says. The cloud enables effective clinical tools, expertise, and algorithms to benefit many patients. “You should get to the point where sequencing should be done locally, analytics can be done on the cloud, and clinical results should be delivered to somebody and impact their care. That’s what’s really exciting,” Shaywitz says.