Precision Cancer Medicine: An Overview

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Precision Cancer Medicine: An Interview with OSUCCC – James' Sameek Roychowdhury, MD, PhD

1. First, what exactly is precision cancer medicine (PCM), and why is it important for the general public to know about?

The term precision medicine comes from a 2012 report from the National Research Council where they talked about how new research tools have helped us understand human diseases on a molecular level. Learning the molecular basis for a disease allows us to determine how to treat people more effectively and precisely. Cancer is an excellent model for precision medicine since it involves genetic changes in cancer cells. Genomic sequencing technologies allow us to study all of the genes in one person’s unique cancer, which is a natural fit for precision medicine. The new precision medicine initiative that President Obama discussed during his address will help advance precision cancer medicine, including obtaining additional funding for genomic sequencing for institutions across the country.

2. What are your thoughts on the president's initiative, and what do you think the impact could be on cancer care and treatment?

The president’s initiative is a wonderful investment in supporting the infrastructure of science, as well as training for people who can help bring precision medicine into practice. The scale of the investment is important when put into context with the cost of cancer. The cost for cancer care per year in this country is about $120 billion, so this investment in research is desperately needed. It can support genomic testing, interpretation of results, initiation of new clinical trials, training of new investigators and young scientists, use of bioinformatics (computer science + biology), and additional genomic training for clinicians.

3. Explain what is meant when the president says precision cancer medicine will "likely move us away from the current organ-based classification of cancer to a molecular-based taxonomy.”

Traditionally when we see cancer patients, we address the type of cancer they have based on the body part or organ in which it originated. Each disease/cancer has specialized needs and care in terms of how it behaves and how we take care of it. However, we now know that not all cancers from the same organ are the same – we need to gather more information about each patient’s cancer on the molecular level. For example, what we call lung cancer may actually be 50 different kinds of cancer based on the molecular fingerprints. As we learn about molecular subsets in each cancer, they may require different treatments based on the genes involved.

4. Please provide some specifics on how the OSUCCC – James is both incorporating PCM in the clinic and advancing it through research.

We have had a Precision Cancer Medicine Program since 2012 when we opened a research study supported by the OSUCCC – James and Pelotonia, the American Cancer Society and the Prostate Cancer Foundation to develop testing strategies for patients with metastatic or advanced cancer in need of novel treatments. At the OSUCCC – James, we supplement what we already know about the cancer in each organ/area through molecular characterization of an individual’s cancer. This allows us to develop innovative clinical trials that can treat individual patients based on their unique cancer’s molecular fingerprint. We evaluate some 200 patients each year and will soon be expanding our efforts.

5. Are there malignancies that you think stand to benefit more than others from precision cancer medicine initiatives – perhaps a type of cancer for which survival/advances have been lagging?

Not necessarily. At the OSUCCC – James, any type of cancer (regardless of organ) is eligible for our study – all cancers need curative strategies. Some have made better progress than others, but that doesn’t mean that we can’t constantly improve upon those.

6. Another concept discussed in President Obama’s initiative is the application of lessons learned from precision medicine to be used in cancer prevention. Can you discuss how much of the current research in precision medicine in oncology is focused on patients with disease vs. cancer prevention? How do these two goals differ?

Our PCM program is geared toward treating patients with very advanced cancer and bringing them new treatment options based on their genetics of the unique tumor.

Separate from gene mutations in a person’s cancer, some patients may have genes that they were born with that may be associated with risk of developing cancer. This happens only about 5-10 percent of the time. This may affect that patient’s family members, so it is important to identify risks that run in families in order to counsel them about screening/preventive measures that may provide better curable outcomes.

An example of this is the Ohio Colorectal Cancer Prevention Initiative (OCCPI), which was started here at Ohio State. Basic research at Ohio State and elsewhere showed how an inherited genetic disorder called Lynch syndrome (LS) can predispose people to certain cancers, including colon and endometrial (uterus) cancer. Through the OCCPI, we are screening colon cancer patients to identify those who also have LS. When LS is found, we screen that patient’s family members to see if they have LS too. For those who do, we can start surveillance methods, such as frequent colonoscopies, that can help prevent colon cancer or detect it much earlier, when it is highly treatable.

This is just one example of how new science-based technologies can help us with cancer prevention and early detection. Heather Hampel, MS, LGC, a professor in The Ohio State University College of Medicine and a genetic counselor at the OSUCCC – James, explains the significance of this work for affected family members: “These are people who haven’t had cancer yet, and we can tell them whether they’re at risk or not. They can get the appropriate screening and keep from getting cancer. This is a very preventable cancer, and genetic testing can save lives.”

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