There were many themes running through the recent American Association of Cancer Researchers (AACR) conference that I just attended in Washington D.C. One significant theme running through the conference was the need to develop personalized medicine to be able to successfully control cancer.
This leads us to the question, What is personalized medicine?
Increasingly, we have come to understand that cancer is a genomic illness (genomics- the study of the collection of all our genes and their interaction with each other and the internal and external environment). As we begin to map the genome we are finding that cancer is derived from problems from inherited genetic material, mutations picked up from environmental exposures and the normal aging process. To successfully treat cancer, we will need to learn how to identify the specific genetic problems and then how to treat these specific, individual genetic abnormalities.
We also have come to understand that people with a specific cancer do not necessarily have the same genetic abnormalities as another person who has been diagnosed with the exact same cancer. People with prostate cancer, or any cancer, may not have the same genetic idiosyncrasy as with other people with the same cancer. This would account for the differences in aggressiveness we see in prostate cancer.
So, prostate cancer, lung cancer and breast cancer etc. are not one disease, all cancers are heterogeneous, even within the same disease type. In most cases, our current level of technology does not yet allow us to differentiate the individual cancers. (ie.- We can not tell the difference between the different types of prostate cancer, we just call all prostate cancer, prostate cancer.) Yet, today we treat cancer. as if it was one disease. The end result, we treat when it might not be necessary, we waste time and money on clinical trials that are doomed to fail at the onset and we often are not successful in treating cancer.
We need to move away from the cookie cutter approach to treating cancer to the personalized approach. Looking at the specific genetic structure of a specific person’s cancer and then learning to respond to the actual genetic structure will allow quicker drug development and true success in the treatment of cancer.
A very clear example of this was presented at the opening session of the AACR 101st Annual Meeting, a lung cancer clinical trial that matched drugs to patients based on a molecular analysis of their tumors took center stage.
This phase II clinical trial, known as BATTLE (Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination), illustrates the potential of using specific treatments that target specific genetic networks and molecular defects that are actually present in a specific individual, in other words, tailoring personal therapy for the personal genetic reality of a specific patient (personalized medicine).
The BATTLE trial evaluated four different drugs in 255 subjects who had stage IV non-small cell lung cancer.
Edward Kim, M.D., (clinical trial leader); associate professor in M. D. Anderson’s Department of Thoracic/Head and Neck Medical Oncology said, “We know that new targeted therapies help a fraction of lung cancer patients, but we haven’t been able to identify who those people are. BATTLE demonstrates the feasibility of a more personalized approach by taking a new biopsy of each patient’s tumor, swiftly evaluating that tumor tissue for specific biomarkers, and then assigning drugs to patients based on that analysis.”
In the study the researchers found one of the four drugs in the trial, sorafenib, didn’t work at all against tumors with one common, more easily treated mutation. However, sorafenib had good effect controlling tumors that featured a KRAS mutation, which has no proven treatment.
By identifying patients in Phase II clinical trials who are most likely to benefit from a specific targeted drug, BATTLE demonstrates that focused Phase III trials will require fewer patients, take less time and will be more likely to succeed.
Bottom line, more treatments, less expense and faster approvals, isn’t that what we need?
The BATTLE abstract at AACR can be viewed here.
Battle Researchers: Edward S. Kim, Roy S. Herbst, J Jack Lee, George R. Blumenschein Jr., Anne Tsao, Christine M. Alden, Ximing Tang, Suyu Liu, David J. Stewart, John V. Heymach, Hai T. Tran, Marshall E. Hicks, Jeremy Erasmus Jr., Sanjay Gupta, Garth Powis, Scott M. Lippman, Ignacio I. Wistuba, Waun K. Hong. University of Texas M. D. Anderson Cancer Center, Houston, TX
Joel T Nowak, MA, MSW