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The Precision Oncology Program for Cancer of the Prostate (POPCaP) Network: A Veterans Affairs/Prostate Cancer Foundation Collaboration

Fed Pract. 2020 August;37(4):S48-S53 | 10.12788/fp.0021
Author(s):
Bruce Montgomery, MD
Matthew Rettig, MD
Jesse Kasten, MHA
Sumitra Muralidhar, PhD
Kenute Myrie, PhD
Rachel Ramoni, DMD, ScD
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Background: The promise of precision oncology only can be realized when genetic alterations are identified that can be leveraged to improve response and minimize toxicity. Identifying those alterations as efficiently as possible and then giving patients access to targeted therapy and clinical study requires a comprehensive strategy across health care systems.

Observations: The US Department of Veterans Affairs (VA) and Prostate Cancer Foundation have established a network of VA centers to help develop best practices for precision oncology for the treatment of veterans with advanced prostate cancer. This article describes the genesis and structure of this network and its potential for contributing to care and research in the VA and the health care system as a whole.

Conclusions: The Precision Oncology Program for Cancer of the Prostate network and its partnership with VA clinical and research efforts is anticipated to provide important insights into barriers and solutions to the implementation of precision oncology for prostate cancer across the VA.
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References

The US Department of Veterans Affairs (VA) is home to the Veterans Health Administration (VHA), which delivers care at 1,255 health care facilities, including 170 medical centers. The VA serves 6 million veterans each year and is the largest integrated provider of cancer care in the US. The system uses a single, enterprise-wide electronic health record. The detailed curation of clinical outcomes, laboratory results, and radiology is used in VA efforts to improve oncology outcomes for veterans. The VA also has a National Precision Oncology Program (NPOP), which offers system-wide DNA sequencing for veterans with cancer. Given its size, integration, and capabilities, the VA is an ideal setting for rapid learning cycles of testing and implementing best practices at scale.

Prostate cancer is the most common malignancy affecting men in the US. It is the most commonly-diagnosed solid tumor in the VA, and in 2014, there were 11,376 prostate cancer diagnoses in the VA.1 The clinical characteristics and treatment of veterans with prostate cancer largely parallel the broader population of men in the US.1 Although the majority of men diagnosed with prostate cancer have disease localized to the prostate, an important minority develop metastatic disease, which represents a risk for substantial morbidity and is the lethal form of the disease. Research has yielded transformative advances in the care of men with metastatic prostate cancer, including drugs targeting the testosterone/androgen signaling axis, taxane chemotherapy, the radionuclide radium-223, and a dendritic cell vaccine. Unfortunately, the magnitude and duration of response to these therapies varies widely, and determining the biology relevant to an individual patient that would better inform their treatment decisions is a critical next step. As the ability to interrogate the cancer genome has improved, relevant drivers of tumorigenesis and predictive biomarkers are being identified rapidly, and oncology care has evolved from a one-size-fits-all approach to a precision approach, which uses these biomarkers to assist in therapeutic decision making.

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