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Subspecialties Oncology, Laboratory management, Genetics and epigenetics

Precision Oncology’s Greatest Tool?

sponsored by Thermo Fisher Scientific

An interview with Rui Manuel Reis

Tell us about your background in oncology…
I’ve worked in cancer genetics since 1996. I started out studying microsatellite instability, then moved to molecular pathology for my PhD. In 2010, I moved to Barretos Cancer Hospital, where I coordinated the implementation of the molecular diagnostics laboratory. It’s one of the largest cancer hospitals in Brazil and, because we only attend to the Brazilian public health system, treatment is free of charge. We do something that is unique in Brazil – deliver state-of-the-art diagnostics and treatment to people who cannot afford private healthcare. And is something we are incredibly proud of.

What are the benefits of precision oncology – and how does genomic profiling play a role?
Put simply, precision oncology allows us to determine the best approach for each individual cancer patient. Genomic profiling is a crucial tool to guide treatment decisions and select a drug that targets each tumor’s particular molecular profile. We mainly use next-generation sequencing because we can evaluate both DNA and RNA alterations, such as gene mutations and fusions. We plan to increase the number of genes reported by tumor type and evolve into a liquid biopsy approach, as well as expand into the use of gene expression signatures.

What is your opinion on in-house testing versus centralization?
We perform in-house testing as it allows us to control the whole workflow – from tissue selection and sample manipulation to generating reports for our clinicians – and we believe that ensures our patients receive a higher standard of care.

In Brazil, most tests are expensive – particularly in centralized labs. But when we test in-house, we can choose the best, most cost-effective method for our needs, giving all patients access to the information that will guide treatment decisions.

Also, it is important to preserve the sample material because it might be required for future tests. Because we have complete control over the tissue block, we can use only what is necessary for our chosen assay. Many centralized labs don’t take the same approach – they use large panels to avoid repetition and often exhaust the sample.

In-house testing also avoids the delays that centralized labs face – the turnaround time is much shorter. This difference is even greater in countries like Brazil, where couriers have to travel long distances.

Finally, because we are a teaching hospital, we can also provide a better training foundation for our interns; not only do our current patients benefit from in-house testing, but our future patients will as well.

How does in-house testing help you address Brazil’s new general data protection regulations?
Genetic data is now categorized as sensitive data. If you want to perform a test, you must obtain written consent from the patient – but we already do that when they are admitted. Sending samples abroad to centralized labs adds a layer of complexity because the patient needs to sign another form specific to the lab receiving their samples. Again, having the in-house lab accelerates this process and provides a faster result for the patient.

How does it affect your collaboration with clinicians?
In-house testing allows us to have conversations about the results with our clinicians during multidisciplinary tumor boards. This helps them better understand the findings, ask questions, and plan the best treatment for each patient, which ultimately leads to better care and outcomes.

What are your thoughts on pharmaceutical companies’ paying for samples to be tested in centralized labs?
I think the problem lies in the size of the panels these labs use. Although broad-spectrum diagnostics may be a great tool in future, there are still only a few drugs available to us that have clear benefits for patients. In my opinion, it’s not ethical to perform a test that generates results that are not actionable; that only gives patients false hope. That’s why, at my hospital, we only perform tests that guide real treatment options.

Rui Manuel Reis is Coordinator of the Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.

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