Cancer treatment, in recent years, has moved away from a “one size fits all” approach toward more personalized care.
Doctors call it “precision cancer medicine.”
In the first part of our three-part series on cancer, WOSU’s Mandie Trimble takes a look at how improved DNA technology is advancing cancer care.
For decades, doctors have designed cancer treatments based on the organ where the disease began. Liver cancer has a different drug regimen than say breast cancer. Lung cancer is treated differently than prostate cancer. But chemotherapy and radiation are the standard therapies.
Researchers, though, have learned cancers, even of the same organ, can be very different based on individual molecular make-up.
New precision care medicine enhances the traditional treatment approach. Researchers use DNA sequencing to get down to the cancer cell’s molecular level to help identify genetic mutations and find out what drives the cancer.
Doctors like Columbus Oncology’s Erin MacRae calls precision medicine the new frontier in cancer treatment.
“It would be a game-changer for cancer therapy if you can test a tumor and know what type of new treatment would work for a certain patient,” MacRae said. “That would really be revolutionary.”
And that could mean some cancer patients with different types of cancer receive the same drugs.
“The ideas and what we’re testing is if this new targeted cancer therapy works in a liver cancer with a certain gene, will it also work in a breast cancer with a certain gene?” Macrae asked.
But researchers first have to identify a cancer gene’s molecular footprint. And that’s what they’re doing in labs and clinical trials around the country.
At OSU’s James Cancer Hospital, researchers use next generation DNA sequencing to classify and catalog hundreds of gene samples on site. Based on the results, doctors match the patient to a clinical trial with a drug known to target the mutation.
Julie Reeser coordinates lab research.
“Say we find a mutation in one patient, they go on some kind of treatment that works really well, we will have that kind of data [so] that if we find another patient with the same mutation we would know that, hey, they might respond to that treatment,” Reeser said.
Patients generally receive results within 10 days. And that’s important because most clinical trials involve patients with advanced stage cancers, like Annie Cacciato from Granville.
Cacciato received her diagnosis Thanksgiving Day 2013. She had Stage IV lung cancer. Cacciato’s tissue samples were sent for genomic testing to see if she qualified for a clinical trial. Her doctor told her…
“What we want to do is root for you having the EGFR mutation because that’s where we’re making great strides.”
As it turned out, Cacciato did have the mutation, which made her eligible for a trial at OSU. In her words, she rang in 2014 with her first round of treatment.
The trial’s goal is to keep Cacciato’s tumors from growing. But scans showed they shrank. Six months later, she was in remission.
“I said, ‘what’s the definition?’ because I wanted to be clear. And remission, at least for lung cancer, means no physical sign of disease. So that was just an amazing day,” Cacciato said. “And I continue to be in remission as I continue my treatment.”
Doctors call Cacciato a “super responder.” While some patient’s cancers are kept at bay, hers are gone. But Cacciato will be on treatment indefinitely, as part of the trial.
“If all these circumstances hadn’t lined up, you know, I probably would’ve had an experience more like the typical statistics for advanced lung cancer patients which is that you don’t survive,” Cacciato said.
Researchers hope precision medicine will narrow down the best course of treatment the first time around. That could mean fewer side effects, improved quality of life and perhaps increased survival rates.
But don’t expect doctors to abandon traditional treatments altogether. Dr. Sameek Roychowdhury is working on precision cancer medicine implementation at Ohio State.
“Many people have wondered: will we ever do away with this in terms of an organ-based versus a molecular-based approach? I think they’re not mutually exclusive,” Roychowdhury said. “I think they’re complementary.”
Precision medicine isn’t standard yet. DNA sequencing tests are used for the sickest patients for now.
“Often times they may not be reimbursed by insurance, sometimes they can be. There are also commercial testing laboratories that are offering similar tests,” Roychowdhury said. ”And basically we don’t do enough testing yet.”
But OSU lab coordinator Reeser, who has been in cancer research for a decade, expects that to change soon.
“So in ten more years, I feel like every single patient that comes in to any kind of cancer hospital will be getting everything sequenced, and they’ll be able to match you to a treatment that will cure you,” Reeser said.