For veterans with prostate cancer, a new center of excellence in Oregon

VA Portland Health Care System and OHSU are launching a precision oncology center of excellence supported by the Prostate Cancer Foundation.

On Veteran’s Day, the foundation announced $5 million in funding for new centers of excellence in Portland and in Boston.

“This award will make it possible for us to reach out to veterans throughout Oregon and Southwest Washington to offer genetic testing and sequencing for all patients with metastatic prostate cancer,” said Julie Graff, M.D., section chief of Hematology/Oncology at VA Portland, and associate professor in the OHSU School of Medicine.

In collaboration with the OHSU Knight Cancer Institute, VA Portland has become a national leader in prostate cancer treatment and research. For example, OHSU and VA Portland enrolled more subjects than any other clinical trial site in the country in the study that brought the first approved drug for men with prostate cancers that have become resistant to hormone therapy but have not yet spread. VA Portland is one of 12 centers across the U.S. selected for a National Cancer Institute initiative to give military veterans more opportunities to participate in cancer clinical trials.

And VA Portland established one of the first centers in the Precision Oncology Program for Cancer of the Prostate (POPCaP) network. These VA centers have made a commitment to provide DNA sequencing to veterans with metastatic prostate and provide access to treatments that would otherwise not be available or appropriate.

“Knowing more about each patient’s specific mutations gives us the knowledge we need to explore more treatment and clinical trial options,” Graff said. “Ultimately, we want Veterans to know they have access to leading treatment and clinical trials through VA Portland.”

DNA sequencing can reveal cancer vulnerabilities that can be targeted with drugs that work by blocking a specific cancer-driving signal. Two targeted therapy drugs, called PARP inhibitors, are approved to treat prostate cancers with specific gene mutations. But full DNA sequencing of tumors and testing for inherited cancer genes is not yet a routine part of care for men with prostate cancer. Research increasingly suggests that it should be. In one study of 3,600 men with prostate cancer, more than 17% harbored an inherited cancer-driving mutation, but 37% of the men would not have been eligible for genetic testing under existing guidelines.

Clinical trials are built in for men with prostate cancer treated at the VA in Portland and other POPCaP centers. Through the Prostate Cancer Analysis for Therapy Choice (PATCH) clinical trials network, veterans are given access to studies at sites across the network. The VA even provides funding for veterans to travel to participate in a clinical trial only available at a distant network site. “We are also developing virtual clinical trials in which we can ship pills to participants and have virtual patient visits where feasible,” said Graff, who is the national director of PATCH.

Across the U.S., the VA health system serves 6 million veterans each year, and each year more than 15,000 men in the health system are newly diagnosed with prostate cancer.  The Prostate Cancer Foundation’s Veterans Health Initiative, established in 2016, is committed to investing $50 million to help bring innovative, best-in-class prostate cancer care to all veterans.

Members of the Portland Center of Excellence team include: Knight Cancer Institute Deputy Director Tom Beer, M.D., Jeremy Cetnar, M.D., Ryan Kopp, M.D., Mark Garzotto, M.D., Amy Moran, Ph.D., Reid Thompson, M.D., Ph.D., Rajan Kulkarni, M.D., Ph.D., and Dean Fong, D.O.

Further reading:

The Precision Oncology Program for Cancer of the Prostate (POPCaP) Network: A Veterans Affairs/Prostate Cancer Foundation Collaboration by Bruce Montgomery, Matthew Rettig, Jesse Kasten, Sumitra Muralidhar, Kenute Myrie, and Rachel Ramoni, Federal Practitioner (Aug. 2020)

Prevalence of Germline Variants in Prostate Cancer and Implications for Current Genetic Testing Guidelines by Piper Nicolosi, Elisa Ledet, Shan Yang and others, JAMA (Feb. 7, 2019)

Leveraging Veterans Health Administration Clinical and Research Resources to Accelerate Discovery and Testing in Precision Oncology by Julie N. Graff and Grant D. Huang, Federal Practitioner (Aug. 2020)