In recent years, the buzzwords in oncology cancer have been “personalized therapy,” in which the entire spectrum of cancer care is customized to the individual patient and his or her cancer. The National Cancer Institute maintains a list of more than 200 types of cancer, which suggests achieving the goal of personalized care for every patient will not come easily.
Advances in molecular cancer research, such as the mapping of the cancer genome (http://bit.ly/cMjbfz
), are helping the process along by allowing clinicians to determine molecular targets in patients’ tumors and select the appropriate targeted therapy—when there is one. One of the interesting things about this approach is the discovery that the molecular makeup of a tumor might be more important than where the tumor occurs. Along these lines, the FDA approved Herceptin (trastuzumab) for HER2-positive gastric cancer in October. Herceptin is already an established treatment for HER2-positive breast cancer, responsible for turning the aggressive often fatal disease into a manageable one for many women. Now, it may be poised to do the same for gastric cancer. It is the only approved targeted therapy for gastric cancer.
The FDA also approved Sprycel (dasatinib) as a first-line therapy for adults with Philadelphia chromosome–positive chronic myeloid leukemia (CML). Ten years ago, personalized medicine was in its infancy and no targeted drugs existed for patients with CML. Now, patients can choose from among 3 options: Sprycel; Gleevec (imatinib); and Tasigna (nilotinib), which was also approved this year.
Other targeted drugs are just over the horizon, like crizotinib in lung cancer and PLX4032 in melanoma. You cannot get much more personalized than immunotherapy vaccines, which are built for each individual patient.
Where personalized medicine gets difficult is development. By definition, personalized therapies are intended for smaller patient populations. This means developing these drugs might be less profitable for pharmaceutical companies. With all the demonizing pharmaceutical companies get in the press, you might expect that they would stop trying to find cures for these small subgroups of patients with a cancer-causing genetic mutation. A few dire predictions have been floated that this might eventually come to pass; but from what we have seen at conferences like the recent 35th Annual Congress of the European Society of Medical Oncology and ASCO’s annual meeting, there is no sign of this so far.