At the genomic level, we now have the tools to detect multiple mutations in the billions of DNA base pairs of cancer cells of a given person’s tumor, and from that information, to select one of several targeted drugs that may be a “match” for that tumor.
IN THIS SPRING issue
, there are two articles that highlight a growing appreciation for the uniqueness of every cancer and the very specific effects it may have on an individual. At the genomic level, we now have the tools to detect multiple mutations in the billions of DNA base pairs of cancer cells of a given person’s tumor, and from that information, to select one of several targeted drugs that may be a “match” for that tumor. We are at the very early edge of this era — yes, we do have FDA-approved biological drugs for certain mutations, but a vast majority of cancer cases do not have such an option yet.
The goal of the NCI-MATCH trial (open nationwide but currently on hold as analysis and adjustment of the genomic tests and results takes place) is to detect genetic defects through sophisticated testing of tumor tissue in patients who have advanced cancer and limited options. If a mutation is found that matches a drug with a track record of responses, the patient can be enrolled. The novelty is that the mutation, not the type of cancer, dictates the therapy. It is expected that most cases will not match to a drug, but as we learn about more mutations and develop drugs that have activity against them, those numbers may change.
NCI-MATCH, one of several basket or umbrella trials
discussed in our article on this topic, is the first large-scale trial of its type, but many more initiatives representing variations on this theme are being launched. It is possible that the future of cancer will be to run tumor tissue (or simply a blood sample) through a “cancer tricorder” (yes, a Star Trek reference!) and come up with an effective tailored formula of biological drugs.
Another article in this issue addresses an equally personalized aspect of cancer — helping survivors with the physical and emotional issues that follow a cancer diagnosis and treatment. Much more focus and funding are being aimed at alleviating the turbulence placed on patients and their communities, and our article looks at some of the clinical trials being conducted in this area. Indeed, there is elegant science exploring innovative ways to address issues like cancer-initiated post-traumatic stress disorder or the bodily disturbances brought on by cancer treatments — these also vary from person to person, so tailored approaches are needed.
Cancer survivors are growing in number and, as a vital part of our society, their health is critical. We must exercise the same thoughtfulness and diligence in this sector as we do in the area of cancer therapy.
DEBU TRIPATHY, MD
Professor of Medicine
Chair, Department of Breast Medical Oncology
The University of Texas MD Anderson Cancer Center