Precision Oncology Program
The Precision Oncology Program (POP) at the SJD Barcelona Children's Hospital is a core pillar in the diagnosis, prognosis and treatment of childhood cancer patients. The programme is rolled out thanks to the Molecular Oncology Laboratory, which focuses exclusively on molecular care provision for pediatric cancer patients, and is integrated into the Laboratory Department at the SJD Barcelona Children's Hospital.
The laboratory's goal is to support the Oncology Area, fulfilling the need for molecular analyses specific to each type of tumour, with the aim of personalising patient treatment based on the genetic characteristics of their tumour. To do this, the lab works in close collaboration with the pediatric oncology team, the Oncology Research Lab and with the Anatomical Pathology Department.
With increased knowledge of the molecular biology of pediatric tumours, their genetic characteristics have been recorded (mutations, epigenetic changes, abnormalities in molecular marker pathways, among others), which play a huge role in the clinical behaviour of these tumours.
The team at the Molecular Oncology Laboratory is specialised in molecular screening, next-generation sequencing (NGS) of tumours, DNA methylation analysis (methylome), and in the development of new techniques to permit, among other things, marker analysis in liquid biopsies. These kinds of analyses have helped improve solid tumour diagnosis, grouping of patients by risk level, and monitoring of treatment response. Since 2019, more than 400 patients have benefitted from the Precision Oncology Program.
The origins of the program
The Molecular Oncology Laboratory's journey started in 2005, and since then, it has progressively expanded its activities. The huge push for the Precision Oncology Program happened in 2019 with the implementation of technological advancements such as methylome analysis and next-generation sequencing (NGS). Additionally, in that same year, the Molecular Oncology Laboratory was integrated into the healthcare activities of the Hospital’s Laboratory Department. This growth was possible thanks initially to the support from associations and families of patients through their fundraising efforts, and then thanks to more competitive financing and subsequent recognition within Spain and Europe.
What does the Precision Oncology Program offer?
The POP is a multidisciplinary programme that integrates precise, targeted analysis of genetic and molecular characteristics of every tumour, alongside a preclinical assessment of drug responses from animal trials, as well as clinical data and individual characteristics of each patient. Planning treatment requires ongoing collaboration in a multidisciplinary team of staff (tumour board), all of whom have deep, specialised knowledge of pediatric tumours. The tumour board holds regular meetings to review and analyse cases and go over various personalised therapeutic strategies for each patient. The goal is to establish the best possible treatment plan, and reduce toxicity and long-term side-effects brought on by treatment.
The Molecular Oncology Laboratory is working towards identifying therapeutic targets that could offer potential clinical benefit to patients who have previously received standard lines of treatment. The molecular tools and technology being used allow for a detailed analysis and assessment of each of the tumours affecting patients.
The Precision Oncology Program is open to patients admitted to the SJD Pediatric Cancer Center Barcelona and to patients from other hospital facilities (national or international), whose case requires one of the precision tests performed by the Molecular Oncology Laboratory.
Each kind of tumour has a different methylation profile (epigenetic signature). The Molecular Oncology Laboratory carries out the genome methylation of the tumour (also known as a methylome) using advanced genome platforms. The methylome, or methylation screening, is a technique that allows for precise definition of tumour types/subtypes, providing information that is vital to therapeutic decision-making.
The Molecular Oncology Laboratory has implemented an NGS panel, which allows for targeted sequencing of the genes relevant to pediatric cancer. Genetic data obtained through NGS allows professionals to detect genetic variants that can help guide diagnosis, prognosis and treatment of patients.
Analysing markers found in liquid biopsies (blood or cerebrospinal fluid) is a minimally-invasive way of identifying significant genetic abnormalities and provide an accurate tumour diagnosis. We have advanced technology available to us that offers precise, targeted analysis of mutations in plasma, serum and cerebrospinal fluid, being of particular use in cases when performing surgery to obtain a tumour sample may be difficult.
For some pediatric tumours, we have access to high-sensitivity, high-specificity, advanced molecular technology, meaning we can identify and quantify the presence of minimal residual disease (MRD) in patients. Analysing specific markers in both bone marrow and liquid biopsies (plasma, serum, cerebrospinal fluid) means we can detect tumour cells early, which would otherwise go undetected using conventional techniques. MRD detection is used to monitor disease progression and guide treatment plans.
What makes us different?
- We have scientific knowledge and analysis platforms that are aimed at detailed study of pedatric oncological diseases. This unique contexts promotes a comprehensive patient-management method: precise diagnosis, rigorous disease monitoring and a personalised treatment plan based on the molecular and genetic characteristics of the tumour.
- Our facility is the first and only centre in Spain to be certified by the German Cancer Research Centre, Heidelberg for our study of methylation profiles (methylomes) in pediatric tumours.
- We have access to a one-of-a-kind Biobank, or pediatric tumour bank. This facility stores biological samples from practically every patient treated in the Oncology Area at the SJD Barcelona Children's Hospital. It is an extremely valuable tool in developing research projects at the hospital and for the international scientific community as a whole.
- Our dedicated pediatric cancer treatment centre, the Pediatric Cancer Center Barcelona, is built on the pillar of developing new therapies for complex oncology patients. This pediatric oncology facility attends more than 400 new patients every year, providing specially-adapted care as per each patient’s needs.
- The Precision Oncology Program at the SJD Barcelona Children's Hospital is based on an integrative and multidisciplinary model. The involvement and collaboration of several departments in the SJD Barcelona Children's Hospital is key to correctly implementing and developing the programme. Our team is made up of members from the Molecular Oncology Laboratory, the Pediatric Cancer Treatment Laboratory (integrated into the Pediatric Tumour Research Laboratory) and members from the Oncology Area and also from the Anatomical Pathology Department.
Platforms in which we take part
- We are part of the LOGGIC Core database scheme, a registry of molecular and clinical data on low-grade pediatric gliomas (LGG). The aim of this collaboration is to share data and improve understanding of the disease's tumour biology, as well as identifying biomarkers and potentially useful targets for new therapies. Sant Joan de Deu is the project's coordinating centre in Spain. The Molecular Oncology Laboratory is the leading central laboratory for Molecular Diagnostics, certified by the Hopp Children's Cancer Center Heidelberg and DKFZ German Cancer Research Center Heidelberg, together with other European hospitals.
- We are taking part in the SEHOP-PENCIL clinical trial (Personalised mEdiciNe for Cancer in chILdren in Spain) alongside other Spanish healthcare facilities. The goal is to facilitate access to precision medicine for all children and adolescents in Spain, regardless of the hospital they are in. The Molecular Oncology Laboratory at the SJD Barcelona Children’s Hospital is the national study coordinator for pediatric tumour DNA methylation, boasting NGS and liquid biopsy capabilities.
- We are one of the many hospitals that take part in the ECLIM-SEHOP platform, with the goal of promoting and developing clinical trials for the pediatric cancer population in Spain. The goal of ECLIM (Ensayos Clínicos Internacionales Multicéntricos [Multicentre International Clinical Trials]) is to overcome existing problems and issues and make Spain one of Europe's leading countries in the advancement of cancer and blood disease investigation, as well as facilitating access to new treatments that improve survival rates and reduce long-term side-effects.