Hear from our experts about MSK's groundbreaking approach to precision oncology and how it is changing the way we treat cancer.
Summary
Three leaders in precision oncology at MSK have released a State of the Union-stylereport on where the field is going. Learn how were already helping people with cancer, and how were uniquely prepared to address the many challenges that still remain in the field.
Highlights
Precision oncology also known as genome-based oncology or personalized cancer medicine is based on the idea that once we understand the genetic alterations that drive cancer cells to grow and spread, we can develop drugs to target them. Memorial Sloan Kettering has been a leader in the field by bringing together lab researchers and clinicians to focus on developing innovative ways to improve care for patients.
The concept seemed wildly futuristic as recently as two decades ago. Now, tens of thousands of people with cancer every year are benefiting from treatment with targeted therapies, which provide more-effective control of tumors while avoiding many harmful side effects common to more-traditional cancer treatments.
Using precision oncology in cancer patients is an attractive strategy, says Barry Taylor, Associate Director of MSKs Marie-Jose and Henry R. Kravis Center for Molecular Oncology (CMO). But its difficult, and there are great challenges. Were really only at the end of the beginning in this process.
More and more stories are coming out of these trials about patients whose cancer has been eliminated by some of these new drugs.
Jos Baselga MSK Physician-in-Chief
These challenges are twofold: Theyre scientific, as the genetic complexities of cancer are not completely understood; and societal, as currently only a small percentage of cancer patients have access to genetic testing and clinical trials.
Dr. Taylor along with MSKs Physician-in-Chief Jos Baselga and Director of Developmental Therapeutics David Hyman this week published an article in the journal Cell highlighting some of the many accomplishments in the field of precision oncology to date and acknowledging the barriers still to be overcome.
This report is like a State of the Union for genome-based oncology, Dr. Baselga explains. Its an in-depth description of where the field is today and where its going. MSK has been engaged in precision medicine for longer than most institutions, and were probably leading more clinical trials in this area than any other center.
The CMO, which was established in 2014 and is just one reason that MSK is at the forefront in this field, aims to identify the functional significance of genetic alterations in tumors so that people with cancer can receive the most individualized treatments. MSKs Human Oncology and Pathogenesis Program (HOPP), established eight years prior, brings together basic and clinical research, with the goal of bringing what happens in the lab into the clinic.
MSKs researchers have also created a genetic sequencing test called MSK-IMPACT, which looks for mutations in more than 400 genes that are known to play a role in cancer. This test is currently offered to all patients with advanced cancers, and the findings from it can help shepherd patients into clinical trials for drugs that are based on the unique characteristics of their tumors. MSK currently has about 30 clinical trials under way that assign patients to targeted therapy based on the results from MSK-IMPACT.
Despite the value in identifying which mutations are responsible for a cancers growth and spread an aspect of precision medicine that MSK and many other institutions are getting better and better at doing this is only part of the battle. Just because we know what causes a tumor to grow doesnt mean drugs are available to fix the problem.
Even for mutations that have effective drugs available, challenges remain. For one thing, tumor cells often evolve and develop resistance to the drugs that once worked against them, much like bacteria develop resistance to antibiotics. More research is needed to determine how this process occurs, and how new drugs can be developed to combat it.
Another aspect of tumor biology that makes precision medicine difficult to carry out is what is called tumor heterogeneity. This means that not all areas of a tumor have the same mutations; therefore drugs that are very effective at destroying one part of a tumor may have no effect on another part, which greatly reduces the chances that it can be completely eliminated.
Precision medicine is changing the way that many clinical trials are conducted.
MSK is already set up to address these challenges through the integration of our scientific and clinical missions, Dr. Taylor says. We have an enormous multidisciplinary team and an institutional commitment to building the infrastructure thats needed to move this work forward. Weve already removed many of the barriers to moving new treatments into clinical trials and collecting as much data as we can on those patients so that others can benefit in the future.
Because of the high volume of patients that MSK treats, both those with common cancers and those with rare ones, were able to identify large populations of patients with specific mutations very rapidly, Dr. Taylor says. This is the first step in designing these kinds of studies in which you are targeting a particular mutation with a particular therapy.
One aspect of precision medicine that MSK has been focused on is improving access to clinical trials. Weve opened up studies to patients at our MSK Cancer Alliance partners, and weve expanded our genetic sequencing out to those centers, Dr. Hyman says. This program is just starting, but the number is increasing.
If an MSK Cancer Alliance site does its own genetic testing, we will open our studies to them so that they can enroll their patients, he adds. If they dont do their own testing, we can analyze patients samples for them.
We've already removed many of the barriers to moving new treatments into clinical trials.
Barry S. Taylor Associate Director, CMO
Another area in which MSK has been at the forefront is expanding precision medicine trials to pediatric patients.
Pediatrics is an underserved patient population as far as trials, but weve been aggressive about lowering the age of eligibility so that younger patients can benefit from these new drugs sooner, Dr. Hyman says. In the past there have been ethical and safety concerns about conducting trials in children, but we think the best way to protect children is to give them access to the same drugs that our adult patients have.
He notes that for drugs that dont have available trials, pediatric patients may be able to get access to them through compassionate-use or expanded-access programs.
A patient describes her successful treatment as a result of participating in an MSK basket trial.
Overall, the way clinical trials are being conducted is changing. The traditional three-phase structure is less important in an era in which a drugs activity and effectiveness can be determined right from the beginning. Some drugs are going right from phase I or phase II to approval, Dr. Hyman says.
Drug development is not going to be easy, Dr. Baselga says. Its not going to be one-size-fits-all. Its going to be one gene at a time and one disease at a time. But more and more stories are coming out of these trials about patients whose cancer has been eliminated by some of these new drugs.
Another area that MSK is also focused on is the analysis of mutations in the DNA code. We need to go beyond genes and look at things on the epigenetic level, Dr. Baselga says. (Epigenetic changes affect which genes are activated to make proteins, without changing the genes themselves.) Investigators are developing new ways to analyze proteins in tumors to look for these kinds of changes.
MSK researchers are also looking at new ways to obtain genetic material to study. One of these methods involves isolating cell-free tumor DNA, which is found in patients blood. This technology, sometimes called liquid biopsy, would enable doctors to monitor patients disease by analyzing their blood, rather than repeatedly having to conduct biopsies. Its expected to provide new insight into how patients respond to targeted therapies, and how resistance develops.
One of the biggest challenges facing precision oncology and the cancer community is the sheer volume of data. Many efforts are now focusing on ways to aggregate findings from genetic studies and pooling the insights gained from clinical trials. One of these is AACR Project GENIE, a multicenter effort being coordinated by the American Association for Cancer Research, to which MSK has been the principal contributor.
Experts say that better data sharing will improve clinical decision-making and provide new information for diagnosis and treatment. Large compilations of data not only serve as a tool for cancer researchers around the world but also help to inform treatment decisions in community oncology centers.
MSK has been an early adopter of many of the approaches to analyzing these kinds of data, and an important part of data-sharing initiatives, Dr. Taylor says. I firmly believe that these technologies should be democratized to all patients, and sharing our data and analysis is an important part of that.
See original here:
- IOM not webcast today. Why Not? - November 8th, 2009 [November 8th, 2009]
- National Academies skeptical at Best. - November 8th, 2009 [November 8th, 2009]
- Some Confusion Exists - November 8th, 2009 [November 8th, 2009]
- Why DTC Genomics IS Medicine. - November 8th, 2009 [November 8th, 2009]
- First Mari, Now Linda. Who's next? - November 8th, 2009 [November 8th, 2009]
- Is it true? - November 8th, 2009 [November 8th, 2009]
- Re-Reviewing the National Academies - November 8th, 2009 [November 8th, 2009]
- The problem with nonclinicians....... - November 8th, 2009 [November 8th, 2009]
- Crazy Night of Emails to Government - November 8th, 2009 [November 8th, 2009]
- Adrienne Carlson's Personalized Medicine. - November 8th, 2009 [November 8th, 2009]
- Tell Me, How do you feel now? Sherpa's RX - November 8th, 2009 [November 8th, 2009]
- This Just In. 23andMe to go to GPs. I love my readers!! - November 8th, 2009 [November 8th, 2009]
- Sorry so long away - November 8th, 2009 [November 8th, 2009]
- 2D6 Rears its ugly head..... - November 8th, 2009 [November 8th, 2009]
- Ok, Fine, Back to Plavix - November 8th, 2009 [November 8th, 2009]
- Kaiser a protoype for Collins' Aim - November 8th, 2009 [November 8th, 2009]
- A few months late to the party.... - November 8th, 2009 [November 8th, 2009]
- Stated Another Way....... - November 8th, 2009 [November 8th, 2009]
- Excuse Me? Harvard and Navigenics? WTF? - November 8th, 2009 [November 8th, 2009]
- Follow up to Yesterday's WTF? Harvard, Navi? and Pfizer??? - November 8th, 2009 [November 8th, 2009]
- Did you get your kit? Thanks Dr. Rob from MedCo - November 8th, 2009 [November 8th, 2009]
- Gluco...Wha? Parkinson's Disease and Glucocerebrosidase mutations. - November 8th, 2009 [November 8th, 2009]
- Away and now back, What did I miss???? 23andme layoffs? Selling Genomes for cheap up next! - November 8th, 2009 [November 8th, 2009]
- Change IS Needed. I agree with William, sometimes. - November 8th, 2009 [November 8th, 2009]
- Good Enough Science? Apparently so at 23andme - November 8th, 2009 [November 8th, 2009]
- Long QT Syndrome, location matters - December 13th, 2009 [December 13th, 2009]
- Congratulations Generation Health. Nice pick up! - December 13th, 2009 [December 13th, 2009]
- An argument 23andSerge can't win...23andme but not medicine - December 13th, 2009 [December 13th, 2009]
- Stop. Breathe. Repeat. An analysis of the direction of DTC Genomics Field. - December 13th, 2009 [December 13th, 2009]
- Hey DTC genomics, Stay Private, Stay Alive, Go Public and Die - December 13th, 2009 [December 13th, 2009]
- You can't have it both way. Either scared your genome is sold off or not. - December 13th, 2009 [December 13th, 2009]
- 15 Days Away Gives Time for Perspective. - December 13th, 2009 [December 13th, 2009]
- What about the SACGHS registry? Another missed opportunity? - December 13th, 2009 [December 13th, 2009]
- AJHG is in and my Favorite Muin is in it! But He Is NOT the Father! - December 13th, 2009 [December 13th, 2009]
- Navigenics for 23andMe prices? - December 18th, 2009 [December 18th, 2009]
- Lp(a) Maybe there's something there that wasn't there before? - December 24th, 2009 [December 24th, 2009]
- Another Year, Another Bankruptcy - December 31st, 2009 [December 31st, 2009]
- 5 Technologies going bye bye in this decade? - January 6th, 2010 [January 6th, 2010]
- Hackers, HITECH and HIPAA in DTC Genomics, Oh My! - January 7th, 2010 [January 7th, 2010]
- Personal Genomics Flop.....big Belly Flop! - January 8th, 2010 [January 8th, 2010]
- Gotta Love It. Even the daycare....... - January 11th, 2010 [January 11th, 2010]
- Congratulations Navigenics. You ARE a clinical lab! Uh-Oh... - January 12th, 2010 [January 12th, 2010]
- CETP, Jewish Centenarians and Alzheimers - January 14th, 2010 [January 14th, 2010]
- Enter the "Not" DTC Genomics Rep - January 17th, 2010 [January 17th, 2010]
- Why Dr. Vanier's Navigenics appointment is good for PM - January 22nd, 2010 [January 22nd, 2010]
- Holy Crap! MedCo Follows in CVS footsteps - February 3rd, 2010 [February 3rd, 2010]
- FDA, Warfarin, still not as sexy to me. - February 5th, 2010 [February 5th, 2010]
- Hype, Hype, Hype from a single study. - February 11th, 2010 [February 11th, 2010]
- I love my readers, even Renata M! - February 17th, 2010 [February 17th, 2010]
- How can insurers use DTC genomics to profile? - February 17th, 2010 [February 17th, 2010]
- 9p21.....ahem. Paynter et.al. Smackdown. Again. - February 18th, 2010 [February 18th, 2010]
- Hey! It's Pete Hulick! Are you Going to GET? - February 19th, 2010 [February 19th, 2010]
- I was wrong......AHEM - February 28th, 2010 [February 28th, 2010]
- G2C2, finally a tool for genomic education! - March 2nd, 2010 [March 2nd, 2010]
- Just 4 million? What 23andMe is worth. - March 5th, 2010 [March 5th, 2010]
- What a difference a year makes - March 9th, 2010 [March 9th, 2010]
- ........DTC Genomic Medicine? - March 12th, 2010 [March 12th, 2010]
- The FDA, 2c19 and the ACC - March 13th, 2010 [March 13th, 2010]
- The problem with Comparative Whole Genomics...... - March 13th, 2010 [March 13th, 2010]
- BRCA testing by 23andME is the same as Myriad Genetics. - March 15th, 2010 [March 15th, 2010]
- The Argument Against DTC Genomics Marketing and such - March 16th, 2010 [March 16th, 2010]
- A moment of Clarity. Some DTCG is not bad. - March 18th, 2010 [March 18th, 2010]
- SNPs for breast cancer risk? It Depends. - March 18th, 2010 [March 18th, 2010]
- How can MDVIP use Navigenics Test for Medicine? - March 18th, 2010 [March 18th, 2010]
- Why did P&G invest in Navigenics? - March 23rd, 2010 [March 23rd, 2010]
- PGx in DTCG? Doesn't stand up to Useful testing. - March 25th, 2010 [March 25th, 2010]
- End of Gene Patents? - March 29th, 2010 [March 29th, 2010]
- Sherpa Accepting Chief Medical Officership - April 3rd, 2010 [April 3rd, 2010]
- The Rumors of My Death........ - April 20th, 2010 [April 20th, 2010]
- Happy DNA Day! - April 25th, 2010 [April 25th, 2010]
- 99 USD, DNA day and patient letters - April 25th, 2010 [April 25th, 2010]
- 2C19, Navigenics and Clinical Reality. - May 1st, 2010 [May 1st, 2010]
- Coriell Personalized Medicine Collaborative rising - May 7th, 2010 [May 7th, 2010]
- Personal Genomes in Clinical Care. Quake paper is a waste! - May 11th, 2010 [May 11th, 2010]
- Personal Genomes in Clinical Care. Quake paper Falls Short! - May 13th, 2010 [May 13th, 2010]
- Last post edited by Drew - May 13th, 2010 [May 13th, 2010]
- GateKeeper? FCUK U! - May 13th, 2010 [May 13th, 2010]
- GateKeeper? F! U! - May 15th, 2010 [May 15th, 2010]
- Potential of genomic medicine, LOST - May 19th, 2010 [May 19th, 2010]
- How Bad Can a House Investigation be for DTC Genomics? - May 20th, 2010 [May 20th, 2010]