Panel of cancer experts highlight advancements in precision medicine

Advancements in the understanding of cancer genetics have led to important breakthroughs in precision medicine, according to a Columbia University media briefing on the future of cancer research.

“The genomic revolution has brought us to a new threshold not only of understanding, but also the promise of effective precision treatments for the many diseases we know as cancer,” Kenneth A. Forde, MD, José M. Ferrer professor emeritus of surgery at Columbia University’s College of Physicians and Surgeons, said during the press conference. “This conversation is going to focus on the future … in the care and cures of cancer.”

The press conference —which was co-sponsored by PBS and Stand Up To Cancer in association with the upcoming documentary Cancer: The Emperor of All Maladies — featured a panel discussion on the future of biomedical research and its use in the treatment and management of cancer.

Dennis Slamon

Panelists discussed how improved knowledge of cell biology has led to a greater understanding of the genetic drivers of cancer and how to treat it.

“One of the most exciting projects that we’ve done was when we found that blood cancer cells don’t live in isolation,” said Siddhartha Mukherjee, MD, PhD, of the department of pathology and cell biology at Columbia University’s College of Physicians and Surgeons. “They make their own homes. They make their environments up. They live in the bone marrow for a very specific reason because they are getting signals that sustain their development within the bone marrow.”

This discovery allowed researchers to develop targeted therapies directed at the cancer growth.

“Instead of playing cat and mouse, we can change the environment cells live in and eradicate the homes so they can no longer keep one step ahead,” Mukherjee said.

Improvements in genomic sequencing technologies have paralleled the progress made in the understanding of cancer drivers. These advancements have been especially important in pediatric oncology, said Andrew L. Kung, MD, PhD, chief of pediatric oncology at New York-Presbyterian/Morgan Stanley Children’s Hospital.

“We are now at a point where every patient we treat, we fully sequence every gene in their bodies, and every gene in their cancers,” Kung said. “The narrative now is that instead of talking about brief remissions, the measure of success is really cure. We cure 80% of all kids who come in with cancer. That success is a strong counter-narrative to those who suggest that we are losing the war against cancer.”

Such approaches have transformed generalized cancer management to a more individualized, precision-based method.

Gary Schwartz

“The genomic revolution has clearly made an impact on some cancers that we were previously treating with a one-size-fits-all approach,” said Dennis Slamon, MD, PhD, of the Jonsson Comprehensive Cancer Center at UCLA. “There are genes that regulate growth, and depending on which genes are broken, there are many pathways to convert a normal cell into a malignant cell. You need to tailor the treatment to that alteration.”

Genomic testing will be an important tool in recognizing the difference between indolent and insidious cancers and to adjust treatment options accordingly, panelists said.
“If we treat too many patients, or we don’t identify the patients that we really need to treat, we’re in a different position of not seeing the forest for the trees,” said Cory Abate-Shen, PhD, of the department of pathology and cell biology at Columbia University’s College of Physicians and Surgeons. “For example, my team has brought into the picture genetic approaches, systems biology approaches, medical oncology, urology and molecular biology to try to understand which prostate cancers need to be treated aggressively and immediately and which of the many, many men would benefit from not being treated at all. I’ve called this precision prevention.”

Although genomic testing is not yet universally available, the panelists suggested that it could become standard practice in the near future.

“The day will come when everybody will need this done,” said Gary Schwartz, MD, chief of the department of hematology and oncology at Columbia University’s College of Physicians and Surgeons. “Whether you’re in an academic center in a major city or in the community, every patient, as part of their initial diagnosis — just as they undergo a physical examination, a chest X-ray or a CT scan — will undergo DNA sequencing in order to understand the nature of the biology and finding the drugs that match that tumor.” – by Cameron Kelsall