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May 4, 2013

BehindTheMedspeak: My Cancer Genome

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Thursday's New York Times front page story about the radical transformation of medicine's view of cancer from tissue-based to gene and DNA-centric serves as an excellent stepping off point for Anne Eisenberg's column in last Sunday's Times, which began as follows: "Cancers were once named strictly for the tissue where they originated in the breast, prostate or other part of the body. Now, in the age of genetically informed medicine, cancers may also come with a more specific lexicon: the names of mutated genes deep within tumors that cause cells to become cancerous."

Excerpts follow.

Even medical oncologists can be daunted by the complexity of these genes and the therapies intended to fight them, said Dr. William Pao, a physician and scientist at Vanderbilt University who studies cancer mutations in addition to seeing patients. "There are so many genes and so many mutations," he said. "The human brain can't memorize all those permutations."

To guide doctors and their patients, many tools are on the market, including one created by Dr. Pao and colleagues: the Web site My Cancer Genome. The site, which started two years ago, is maintained by 51 contributors from 20 institutions. It lists mutations in different types of cancer, as well as drug therapies that may or may not be of benefit. Most of the drugs are in clinical trials; a few have been approved by the Food and Drug Administration.

The typical user of this information is an oncologist, Dr. Pao said. At the Web site, the doctor can select "melanoma" and "BRAF," for instance, or "lung cancer" and "BRAF," and see all types of mutations in the BRAF gene that occur in those instances. The doctor can then check for national and international drug trials aimed at these alterations.

Different treatments may work in different molecular subsets of cancer, depending on the mutation. More than 700 oncology drugs are now in development, many aimed at DNA defects, Dr. Pao said, "and the number will only accelerate."

"We are moving away from the tissue of origin to the molecular basis of the cancer, using the mutation to search for a treatment," he said.

Users do not pay to access the Web site. "Our premise is that much of the discovery work was paid for by taxpayer dollars," he said, "so the site is public and freely available." The site is supported almost entirely by the university and by philanthropy.

Before doctors go to My Cancer Genome or a similar site, their patients must have a diagnostic test to find relevant mutations. At one time, such tests were limited mainly to patients at large university cancer centers, and were often hard to interpret, said Dr. Fadi Braiteh, an oncologist who practices at Comprehensive Cancer Centers of Nevada in Las Vegas. Now tests for the mutations and the analyses of the results are available to neighborhood doctors.

Dr. Razelle Kurzrock, director of the center for personalized cancer therapy at the Moores Cancer Center at the University of California, San Diego, says she thinks that comprehensive tests... will be invaluable in the future. "We have to know what's inside a tumor cell that is causing it to grow," she said, "and match that knowledge up with the specific drug that targets the abnormality."

[Illustration up top by Julia Yellow]

May 4, 2013 at 12:01 AM | Permalink


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