More and more patients may be asking their doctors this question. Are you ready to give them the best answer?
Last week, MPT Washington correspondent Emily Walker published a nice piece on the "unimagined progress" in research cancer over the past four decades. In her story, based on the 2011 American Association for Cancer Research (AACR) , she writes about the genetic etiology of cancer and the hundreds of genes related to its cause and biological behaviors. Walker also notes the dozens of new therapies -- targeted at specific molecular defects -- which hold the potential to transform some cancers into manageable, chronic illnesses.The process by which pathologists diagnose the specific cellular defects that may be "driving" a patient's tumor is called molecular subtyping (or profiling), which occurs following routine histo-pathologic diagnosis. Advanced diagnostic technologies derived from genomics are enabling pathologic descriptions of unprecedented detail and precision. For example, did you know that about 4% of multiple myeloma tumor genomes harbor a mutation that is typically associated with malignant melanoma?
In a singular case that we reported on last April, author and journalist Christopher Hitchens (pictured right) had the genome of his metastatic esophageal carcinoma "decoded" with the help of National Institutes of Health Director Francis Collins, MD, PhD. The results suggested that Hitchens might benefit from a targeted cancer drug, Gleevec (imatinib), normally only used (and only FDA-approved) to treat chronic myelogenous leukemia and gastrointestinal stromal tumor. We don't know the results of Mr. Hitchens' "N-of-1" therapy, but his case and portend a time when cancer is no longer defined by the organ system in which it arises but rather by the underlying mutations in the cells that cause various molecular pathways to go awry. How close are we to routinely individualizing a patient's therapy based on the unique set of mutations found at the time of diagnosis or recurrence?
A young company named is betting that we're closer than you think.
Founded about three years ago by Harvard-trained internist Dr. Jennifer Levin Carter (pictured left), N-of-One works directly with cancer patients and their doctors to provide access to "molecular profiles" of the patients' tumors which may suggest targeted alternatives to standard chemotherapy.Examples of new drugs targeted to specific genetic mutations in patients' tumors are described and explained in the and have received a great deal of media attention. recently expressed concern over the "hype" accompanying this media attention, using as example Hoffman-La Roche's new melanoma drug which targets metastatic melanoma cells, but only those that harbor the V600E gene mutation.
Molecular testing could identify both patients who are most likely to benefit from the new drug, but also patients lacking the V600E mutation. The former situation benefits the patient. The latter situation benefits insurance companies through the mechanism of "cost avoidance."
The FDA recently sought "guidance" on its promoting the development of "companion" diagnostic tests to be used with targeted drug therapies.
Recently Dr. Carter's N-of-One teamed up with GE-Clarient Healthcare to produce a new informational web site called "Is MY cancer different?"
What do you think?
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