What is GENEPI and why was it created?
In current radiotherapy (RT) practice, standard radiation doses are prescribed to treat malignant tumours and, in some instances, benign disease. Dose prescription and fractionation schedules are based on experimental research and empirical knowledge derived from decades of careful clinical observation. Still, RT fails to achieve tumour control in at least 25% of the patients and at least 5 to 10% of those cured experience adverse late effects affecting seriously the quality of their lives.
Radiation research seems to point to a genetic basis for the variation in the individual response to radiation. However, the yet unanswered question is: which of the more than 50 genes activated by low or high dose radiation, hold the key to the variation in this individual response and can therefore be targeted for predictive tests?
The possibility to tailor dose prescription to the individual radiosensitivity of each patient could indeed be a quantum step forward in decreasing adverse effects of radiation while at the same time enhancing the efficacy of treatment of tumours and thereby outcome. Thus personalised, biologically optimised RT treatments will be a major contribution to improving cancer cure rates. This is the eventual long term aim of the GENEPI project.
Aware of the enormous potential of applied genomics for the biological optimisation and individualisations of radiotherapy (RT) and for improved radioprotection of patients and faced with the fact that only a handful of European radiobiology labs had access to human tissues suitable for this purpose, the European Society of Therapeutic Radiology and Oncology (ESTRO) made a decision in 2002 that represented a significant departure from its traditional role (fostering RT through exchange of information, quality assurance and educational initiatives): to play a more active role in stimulating and supporting large scale European research networks.
As a first step an adequate infrastructure was needed. A large normal and tumour tissue bank was to be created dedicated to research in the response to radiation. Only samples of patients whose late effects had been carefully documented after their radiotherapy treatment would be included. Both prospectively collected samples and tissues obtained in past collaborative trials would qualify. A possible avenue for realizing this plan was found in the EURATOM radiation protection priorities for the European Commission's 5th Framework Programme (FP5). A proposal seeking support for such a project was submitted and granted. GENEPI-Entb 1 GENEtic pathways for the Prediction of the effects of Irradiation - European Normal and Tumour tissue Bank and database, the European normal and tumour tissue bank and database was born and soon thriving, attracting strong and motivated partners.
One might wonder what value the ESTRO initiative could possibly still add to the countless tissue banks already available to large scale biotechnology research worldwide. The key distinguishing feature for the unique relevance of the GENEPI project to the EURATOM policy objectives in the field of radiation sciences is that the tissue bank will be linked to an accurate documentation of RT treatment parameters and detailed treatment outcome data both on normal tissue reactions and on tumour response.
When opening the GENEPI tissue bank, a commitment was made to expand it in the future and to keep it open for a minimum period of 20 years. Right from the beginning it was clear that to enable the selection of homogeneous cohorts of patients with respect to variables such as age, sex, tumour histology, treatment and follow up regimen, a database with full documentation on up to 12.000 tissues would be necessary. To achieve this, continued support needed to be found.
This led to GENEPI- Entb 2 and the first GENEPI research project - GENEPI-lowRT, Both projects are EURATOM FP6 funded projects.
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