Tailoring Radiotherapy Using GARD
By: Tammy McCausland
Content in the blog post is adapted from an article published in Radiation Oncology News for Administrators Vol 31 No 4.
Genomic-adjusted radiation dose (GARD) shows great promise in helping clinicians tailor radiotherapy treatments for patients. SROA first published an article about GARD in 2017. A new study about GARD published in The Lancet Oncology “validates the association between GARD and radiation therapy outcome in a large cohort of patients, across seven different cancer types.” These cancers include cancers of the breast, head and neck, endometrium, melanoma, glioma, pancreas and lung (NSCLC).
GARD quantifies the biological effect of the delivered dose on a patient.
The study showed that GARD reveals more about the benefit of radiation therapy than the physical dose. According to the study, GARD is “a dynamic parameter that changes based on the prescribed RT dose, which allows the clinician to directly modulate it. The higher the GARD value, the higher the predicted therapeutic benefit of radiotherapy at that specific dose.”
Jacob G. Scott, M.D., Cleveland Clinic radiation oncologist and Case Western Reserve University School of Medicine associate professor, said, “Radiation oncology has, in the last 30 or 40 years, been focused on better anatomic precision and about who does and doesn’t need radiation therapy. There’s now a better way to dose our patients . . . I think there’s an underlying unspoken assumption that we’re doing the best we can with radiation, and now our data really show that there’s an opportunity to do better, and that is exciting to me.”
The first step with GARD is ordering a genetic test (like Oncotype) that takes 10 genes from the patient’s tumor, sequences them in a specific way, and gives a gene-expression-based radiation sensitivity index (RSI) score for that patient’s tumor. GARD is a decision support tool that a clinician can use to determine how individual radiation doses would help a patient. “The test [GARD] provides some more information that the treating physician can use to make a decision in the clinic. . . . What we’re going to do is give them [clinicians] more information about how their patient will respond to radiation, and then they can make the decision on their own,” said Dr. Scott.
GARD has far-reaching implications. “This is really the first opportunity we have in radiation oncology to use personalized medicine for our dosing scheme. We’ve done an amazing job in our field, the medical physicists in particular, of personalizing dose shape. . . . GARD gives us an opportunity to start the learning process again for personalized dosed escalation or even de-escalation. It’s a really big shift in the way we think about prescription dosing,” said Dr. Scott.
Cvergenx, Inc., a genomic informatics company, is collaborating with a large U.S. genomics vendor to make the GARD test available commercially. The GARD test is available from a CLIA laboratory at Moffitt Cancer Center. Once commercialization happens, a physician will get a GARD report, which will help them to tailor radiation dosing to their individual patients. GARD can help determine who would benefit from dose escalation within existing safe limits.
“The ultimate goal of GARD is to provide the right dose to the right patient. Right now, it’s one-size-fits-all dosing, and we really look forward to a day when each patient gets just the dose they need,” said Dr. Scott.
Currently, patients would have to pay out of pocket for the GARD test. The goal is to payers to cover the cost. The price would be similar to Oncotype.
Are you excited by opportunities for personalized radiotherapy for cancer patients?
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Related Content:
Radiation Oncology News for Administrators, Vol. 31 No. 4
A new study about GARD
Links:
Society For Radiation Oncology Administrators (SROA)
Radiation Oncology News for Administrators, Vol. 31 No. 4
Cvergenx, Inc.
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