The Make-an-IMPACT initiative is a direct-to-patient outreach effort that offers free clinical tumor genomic testing to patients with select rare cancers. Memorial Sloan Kettering Cancer Center currently offers tumor genomic testing to all MSK patients with recurrent or metastatic cancer. Testing is currently performed using the MSK-IMPACT™ assay with return of results to patients and their local physicians. MSK-IMPACT™ is a targeted, next generation sequencing assay that can detect missense mutations, small insertions/deletions, copy number alterations and select fusions in 468 cancer-associated genes. Over 18,500 tumors have been sequenced since initiation of the program in 2014 resulting in a dramatic acceleration of enrollment of patients to precision medicine clinical trials.
Make-an-IMPACT seeks to increase the number of patients with select rare cancers offered tumor genomic testing by offering the clinical MSK-IMPACT™ test free of charge to patients with select rare cancers. Currently, the program is open to patients with ovarian germ cell tumors, chemotherapy refractory testicular and mediastinal germ cell tumors, cholangiocarcinomas, pediatric cancers of varying histology, histocytosis and mammary secretory carcinomas of the breast. The latter two tumor types were chosen as pilots as they often harbor mutations in genes for which MSK currently has active clinical trials with promising early results. Patients are consented by phone and mail to allow for research non-billable tumor genomic testing. All tumors undergo a formal pathology review and MSK-IMPACT™ testing with results returned to the patient and their local physician. Consent is also obtained for further research analysis including whole genome sequencing, RNA sequencing or other molecular profiling assay.
In a recently funded joint effort between MSK and the Broad Institute, patients with treatment refractory germ cell tumors will have clinical MSK-IMPACT™ testing with return of results following by whole genome and transcriptome sequencing as a research discovery effort. Return of clinical sequencing results to patients will facilitate patient enrollment onto mutation specific clinical trials. The goal of the whole genome/transcriptome studies will be to identify novel mediators of treatment resistance and disease pathogenesis in patients with germ cell tumors. Given the rarity of this cancer type, we believe that this study is only feasible through a direct-to-patient outreach effort.