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precision medicine: precision medicine
Nine generations ago, an ancestor of Marc R. Matrana, MD, MS, FACP, battled for the souls of Louisianans by building the first church in New Orleans. Today, he is waging a different battle and fighting to save the lives of cancer patients, both in clinic and in the halls of Louisiana's legislature.
Marc R. Matrana, MD, MS, FACP: Marc R. Matrana, MD, MS, FACP
As Director of Precision Medicine at Ochsner Health System, New Orleans, Matrana helps patients combat cancer by using genome sequencing to identify specific cancer mutations and guide patients toward the most precisely targeted therapies available.
Beyond the walls of his clinic, he has testified before the Louisiana state legislature to explain the importance of genetic testing in precision medicine, the necessity of its universal availability, and a guarantee of coverage by health insurers for all state residents. He also has lobbied to make sure cancer patients without medicinal therapeutic options be allowed to try any drugs that may work on their specific mutation, even if the drug is not fully approved or only is approved for other cancers, with insurers covering the expense.
Thanks to these Herculean efforts, bills with just such assurances sailed past the legislature with unanimous “yes” votes—a rare occurrence in these fractured political times—and were signed into law by Governor John Bel Edwards. Additional patient-centric bills have passed, and others are on the way. Now working with like-minded advocates under the name Cancer Advocacy Group of Louisiana, Matrana noted, “We also passed a law mandating that mammography not just be done strictly once a year, but rather according to patients' risk factors due to genetics or other things. Now insurance companies must pay for the extra screening when it's required and could possibly save a life.”
Currently, the group is working on bills pertaining to biomarkers, greater interchangeability for electronic health records, “...and a bill for fertility preservation for young cancer patients. For those undergoing therapy that might destroy their fertility, the bill mandates coverage for sperm banking or preservation of eggs,” Matrana detailed.
The success of such proactivity will result in lives—thousands of lives—saved or improved. His efforts have been honored with the presentation of The Cancer Community's 2022 Catalyst for Precision Medicine Award.
Not So Typical
Who is this tour-de-force clinician/advocate? As Matrana tells it, he's a “typical” family man, married for 13 years to Heather, who runs a colon and rectal surgery group at Ochsner. Together, they have a son, 8, and a daughter, 4. So... family man? Yes. Typical? No way. Matrana was born, raised, and educated in Louisiana.
“I had some medical problems in high school that were all resolved, but just seeing doctors and the work they did caused me to picture myself as a doctor,” he told Oncology Times.
After earning a master's degree in human genetics at Tulane University, Matrana went on to medical school at Louisiana State University where he discovered an affinity for oncology. “I wanted to enter a field where I could use my genetics training. I wanted a field that was moving very fast. And I wanted a field where I could treat sick patients as opposed to patients seeking routine care. I wanted patients with whom I could develop deep, meaningful relationships and make a big impact over time. Oncology was just the right fit for me.”
During his last year of medical school, Hurricane Katrina removed any vestiges of “typical” training from his life. “Katrina changed everything about our lives. We didn't have mail service for 6 months. We didn't have electricity. We didn't have running water. New Orleans seemed completely lost in lawlessness; people just had to fend for themselves,” Matrana recalled vividly.
“I ended up at the University of Mississippi for a period because that's where I had been evacuated to,” he said. “By the time I got back to New Orleans, LSU medical school had established military-style MASH tents at the convention center. We had no running water and only generator-powered electricity. But I got to work there, and that was an amazing experience.
“I was doing things a fourth-year medical student never would have done under normal circumstances,” Matrana admitted, “but they needed to be done. We were treating heart attacks and strokes in dim tents with no running water and it went on for months. I remember walking to my car one night in the pitch black because there still were no streetlights. And just on the other side of a chain link fence, in downtown New Orleans, I saw a coyote. It was as if all the streets were surrendering to nature. I remember thinking, ‘Oh my God, that coyote literally can just run over here and eat me.’ I hightailed it to my car.”
Once he graduated from medical school, Matrana had a decision to make. He could leave hurricane-ravaged New Orleans for greener pastures, or he could stay. “Before Katrina, I had considered leaving, but after Katrina I said to myself, ‘The city needs me.’ So, I stayed. In fact, a lot of us [medical school graduates] stayed. Ochsner was the only hospital open and operating at that time, so I did my internal residency there.”
However, after the city stabilized, Matrana spread his wings a bit. “I wanted to enter a world-class oncology training program, so I went to MD Anderson where I became chief fellow. It was phenomenal. But 3 years away from New Orleans was enough. I'm a ninth-generation New Orleanian; I missed the Mardi Gras, the traditions, the food—everything. I had already married before my fellowship; I really missed my wife who was still in New Orleans. It was time to come home.”
Cancer Alley
While New Orleans may best be known for its Mardi Gras, Preservation Jazz Hall Band, sumptuous gumbos, and tantalizing beignets, it also has a darker side. Some people call the region “Cancer Alley.” According to Matrana, “The 13 parishes that go from Baton Rouge through New Orleans to the Gulf of Mexico where the Mississippi River flows is termed Cancer Alley because of across-the-board higher rates of cancer and poorer outcomes. We find that many cancers—multiple myeloma, for example—are diagnosed in much younger patients and as much more aggressive diseases than in other parts of the country.” But why?
“What's different about that area from other parts of the country is that the river, lined with sugar cane plantations in the 1800s, is now lined with petrochemical plants. You see chemical plant, after chemical plant, after chemical plant,” Matrana detailed.
Might one conclude the cancer rate is because of the chemicals being pumped into the river or the surrounding soil? “It's hotly debated, but absolutely,” Matrana said. “There appears to be no other reason. There are some communities in the river parishes, the deepest part of the biochemical industry in the thick of Cancer Alley, where every single household has active cancer. Yes, there's an active cancer patient in every house on every block on every street in those communities. It's horrible.”
When asked why anyone would live there, he explained, “Many of the people who live in those areas with the chemical plants are literally the descendants of the slaves who labored on the sugar cane plantations. That's very cheap real estate now. The families have been there for 200 years, and they just don't have the means to go anywhere else. So, this creates a generational pattern of illness.”
Precision Medicine Emerges
When Matrana returned to New Orleans following his fellowship at MD Anderson, he also returned to Ochsner Health to be an oncologist and participate in large research projects. “In fact, I was brought in to help build up the clinical research program. Eventually, I was asked to develop an early drug development Phase One program. Inherent in that were many of the new drugs being developed for cancers with specific mutations, targeted therapies, etc. So that meant we had to test all the patients coming through and sequence their tumors for these mutations in order to pair them with trials. Very quickly our program became a precision medicine program.”
It all relied very heavily on precision medicine to make it work. “Suddenly, the precision medicine took on a life of its own,” Matrana recalled. “Other departments started contacting us and we [began] getting into pharmacogenomics. We [conducted] whole genome sequencing in our NICUs to come up with diagnoses for babies who were not thriving and who did not have a diagnosis. We also started doing behavioral health pharmacogenomics to enable us to pick the right antidepressant for patients suffering from depression. All sorts of other aspects fit together.
“I'm at a point now of taking precision medicine system-wide, even regional-wide, across different specialties,” Matrana noted. “Building a precision medicine institute and lab is my biggest focus. It's truly a new field of medicine that is emerging. I told our former CEO, ‘In 15 years, I don't think we're going to have this term precision medicine. I think we're just going to call it medicine.’”
Asked how this move toward precision medicine helps those cancer patients who come in from Cancer Alley, Matrana said, “A lot of these patients' tumors are automatically sequenced at the time of pathologic diagnosis. We follow a very sophisticated algorithm that we've developed with pathology based on the type of cancer and the stage of cancer a patient has. We're looking for what we call underlying driving mutations causing cancer to develop, grow, and spread. We're looking for actionable mutations driving this cancer that we can target with specific drugs. When we pair patients with specific mutations with the correct drugs, outcomes are dramatic.”
Matrana made a point of noting Ochsner's sequencing protocol takes one step out of the hands of doctors. “The sequencing is done automatically, because of those laws we were able to pass that mandate testing coverage. Prior to that, not everyone had the coverage they needed to get testing. Now, by the time a newly diagnosed patient gets to the oncologist, our goal is to have their tumor already sequenced and their genetic information staring the oncologist right in the face on the computer screen,” he stressed.
It's a big step toward healing health disparity in Cancer Alley, and beyond. “Here in Louisiana, the great majority of people are going to pay little to nothing for this amazing technology that would have cost an individual upwards of hundreds, if not thousands, of dollars,” Matrana stated. “I think the laws in Louisiana are going to serve as an example of what other states, or perhaps the federal government, can do. We're certainly looking toward that.”
In a continuing effort to fight health disparities, “Ochsner Health has made a commitment to invest $100 million specifically to increase the health of our communities and really bring up the health of low-income, underserved, minority-based communities,” said Matrana, proudly. “We have a program the institution is running called Healthy State, which we informally term ‘40 by 30.’ If you look at the health rankings of the country, Louisiana always ties with Mississippi for 49th or 50th.
“So, we've made a commitment to do whatever it takes to bring our ranking to 40th by 2030. Part of that $100 million is being used to build community health centers [and] big clinics with community resources in underserved communities that do not have great access to medical care. We already have several centers in these areas with more on the way.”
Valerie Neff Newitt is a contributing writer.
