EXaCT1 Testing?

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mpbser
Posts: 928
Joined: Wed Apr 19, 2017 11:52 am

EXaCT1 Testing?

Postby mpbser » Fri Oct 04, 2019 10:53 am

Is anyone familiar with EXaCT1 testing or other Whole Exome Sequencing?

Did you have it done? What did it tell you that you already didn't know about your cancer? How did it help guide you through treatment options?

Here is what is on Weill-Cornell's website about it:

Whole Exome Sequencing by Next Generation Sequencing (NGS) has emerged as an efficient strategy to selectively sequence the coding regions of the genome as a more-cost effective alternative to whole genome sequencing. This new approach allows for the identification of numerous gene variations that may yield information about your cancer's development, prognosis and any potential targeted therapies that currently exist.

Unlike focused tests, typically called panel sequencing, the EXaCT-1 assay takes an unbiased, exploratory look at more than 20,000 genes in both healthy and malignant cells, allowing molecular pathologists to find alterations in the cancer-development process in unexpected regions of the exome. This type of test, known as whole exome sequencing, can be effective in advanced-stage patients for whom other treatments have failed because it uncovers mutations that the less comprehensive tests miss. In practice, this means, for example, that a patient with bladder cancer whom EXaCT-1 shows to share a mutation associated with breast cancer might benefit from a drug typically prescribed to fight the latter type of tumor.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

fumaros
Posts: 267
Joined: Sat Jul 02, 2016 10:26 pm
Location: Syracuse, NY
Contact:

Re: EXaCT1 Testing?

Postby fumaros » Mon Oct 07, 2019 8:23 pm

I had Next Gen sequencing on the biopsied tissue of my tumor. The results provided the mutation profile of my tumor and the percentage of cells that had any specific mutation. The most significant find was the KRAS G12C mutation. This told the oncologist that certain EGFR targeting chemotherapy drugs would not work, and it was also necessary for applying for certain clinical trials that target specific mutations.

Hope this helps.
Diagnosed 4/8/16, age 29
Colectomy 4/20/16
Stage III, T4bN1 Tumor 7x6.5x2. Muscinous Adenocarcinoma with SRC features
2/16 lymph nodes
Stage IV, Peri mets 5/2019
CEA 4/14/16 - 16.8
CEA 6/2/16 - 1.9
CEA 6/17/16 - 0.87, 7/16 - 1.33, 12/16 - 1.14, 4/17 - 0.6, 7/17 - 0.5, 10/17 - 0.9, 3/19 -5.8, 4/19 -10
FOLFOX began 6/24/16 - 11/25/16, FOLFIRI - 5/10/19
10 round FOLFOX, 2 round 5-FU & Leucovorin, 1 round FOLFIRI
MRI & CT 8/16 - NED, CT 12/16 - 10/17 - NED

NHMike
Posts: 2272
Joined: Fri Jul 21, 2017 3:43 am

Re: EXaCT1 Testing?

Postby NHMike » Tue Oct 08, 2019 6:59 am

I looked it up as the name isn't necessarily descriptive.

It is genetic testing (not genomic testing on the tumor) and looks for genetic coding and variants or mutations that may be of use in treatment. I saw that there are research papers on this but I didn't read any of them. They would probably be a good place to look to determine how useful this testing is.

https://en.wikipedia.org/wiki/Exome_sequencing
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

mpbser
Posts: 928
Joined: Wed Apr 19, 2017 11:52 am

Re: EXaCT1 Testing?

Postby mpbser » Wed Oct 09, 2019 6:03 am

I like how Whole Exome Sequencing finds mutations that less comprehensive tests miss. If, for example, EXaCT-1 shows my husband's liver met (I assume Weill-Cornell is testing the met to the liver because I made the slide request to MSK) shares a mutation associated with breast cancer, he might benefit from a drug typically prescribed to fight the latter type of tumor. Because of this, I can see why the description says that the test "can be effective in advanced-stage patients for whom other treatments have failed." My husband is nowhere near treatment failure as so far, none of his treatments can be said to have failed, but I am glad that we will have as much information as technologically possible.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED


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