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When it comes to treating patients with rare cancers, treatment options are often limited and unfortunately less effective. The problem treating physicians face is that there isn’t much known about these rare cancers due to the lack of clinical research and clinical trials in this area.

At Moffitt Cancer Center, researchers are looking to improve the care for patients with rare cancers, such as pelvic squamous cell carcinomas, through genomic profiling. This method is used to learn more about a person’s genes or specific cell types and the way those genes interact with each other and their host immune microenvironment. It is also used to help develop new ways to diagnose, treat and prevent these cancers.

head shot of Dr. Phillipe Spiess

Dr. Philippe Spiess, Assistant Chief of Surgical Services & Senior Member of the Department of Genitourinary Oncology

“We wanted to take a deep dive from a research standpoint and look at how different these cancers are similar or differ. When we study and treat patients, we're making treatment decisions based on tumor histology and organ of origin but in this work, we wanted to know at a fundamental level how different are they beyond just being forms of pelvic squamous cell carcinoma tumor histology, rather at the level of genomics how can they be contrasted,” said Dr. Philippe Spiess, assistant chief of Surgical Services and senior member of the Department of Genitourinary Oncology at Moffitt. “I think it leads us to opportunities to personalize our therapeutic approaches.”

The study presented during the recent American Society of Clinical Oncology annual meeting looked at over 1,700 cases of pelvic squamous cell carcinomas, which included penile, anal, vulvar, urethral and cervical cancers. It analyzed at the genomic level the similarities of the tumors, looking at commonalities in terms of specific mutations that are found, as well as the differences.

“This work allowed us to establish potential novel targets to treat these tumors,” said Spiess.

Many pelvic squamous cell carcinomas are historically associated with the human papillomavirus virus (HPV) and often lead to physicians providing similar systemic approaches among patients with advanced disease. But the data showed that in certain instances, they differed widely in genomic alterations and HPV status, leading researchers to believe that there are better treatment options for patients and these are based on using a genomic profiling-based approach most notably in tumors not responsive to conventional treatment strategies.

“We saw that urethral cancers are very different from penile cancers, and although sometimes we treat them somewhat similar in terms of chemotherapy, surgery and radiation,” said Spiess. “But they are very unique, and importantly, they have a unique genomic type of mutation, which we could use to target various novel agents and potentially improve how we care for our patients.”

Spiess says that the next evolution in oncology is defining personalized genomic signatures for these tumors. As part of a broader international collaboration with colleagues at other international cancer centers and Foundation Medicine©, he plans to explore the development of smaller clinical trials using the data from this study among other work in this area he is conducting, specifically targeting the same pathways to help ultimately improve the care of patients in the months and years to come.