An ambitious cancer treatment initiative is taking place in Maine. Funded by a philanthropic gift, the Maine Cancer Genomics Initiative, run by genomics experts at Jackson Laboratory, based in Bar Harbor, is connecting a network of community-based cancer treatment centers to “change the paradigm of how we are delivering care,” according to Jens Rueter, M.D., medical director of MCGI.

The project is unusual because it is not in an academic medical center, which would typically house the initiative. Instead, says Rueter, the MCGI will begin to answer questions about how to engage community health systems in delivering genomic medicine. Cancer patients enrolled in the initiative will be tested for 358 genes that have been designated clinically actionable. The identified genomic variants and potential response to therapy or availability of clinical trials matching the gene variant are run through Jackson Laboratory's Clinical Knowledgebase, and results are returned to the physician in a report.

The ultimate goal, says Rueter, is to offer physicians clinical-decision support backed by a robust, searchable database that can match patient tumor characteristics, treatments and outcomes to guide future patient care. Rueter expects that the MCGI and other similar initiatives soon will lead to matching genomic variants with treatments for which they are not currently approved by the Food and Drug Administration. Such off-label use will require a database of evidence to convince payers and the pharmaceutical companies to support off-label use. All of this will require a support infrastructure, and MCGI is helping to build it.

“We are working on raising the options for patients here in Maine,” says Rueter. “And that needs to be done in any health care system where such an initiative is implemented.”