Thomas J. Lynch, MD, director, Yale Cancer Center, Physician-in-Chief, Smilow Cancer Hospital at Yale-New Haven, writes about precision medicine in oncology.
Thomas J. Lynch, MD
As a practicing oncologist for twenty-five years, there are two questions I’ve heard from nearly every patient diagnosed with cancer, “Why did I get this,” followed immediately by the more urgent one, “Can this be cured?”
Thanks to our ability to molecularly profile cancer, we can begin to answer the first question and be much more optimistic about the second. Academic centers like Yale Cancer Center and Smilow Cancer Hospital are already performing molecular profiling for more than a dozen types of cancer. Increasingly, we are finding solutions that did not exist even a few years ago. These solutions can extend patients’ lives or provide less toxic treatments.
This is why so many doctors and scientists working in major genetic diseases like cancer, Alzheimer’s, diabetes, and cystic fibrosis, heartily welcomed the recent news of President Obama’s “precision medicine” initiative. The President called on Congress to invest $215 million in deeper research, technology, and collaboration so we can move beyond the inadequate one-size-fits-all treatment model we’ve been largely dependent upon for decades.
When colleagues and I sit down with newly-diagnosed patients, we almost always need to explain that cancer is a set of complex diseases, perhaps several hundred, which can behave quite differently from one another. Not only does breast cancer behave differently than lung cancer, but even within breast cancer, there are at least two dozen subtypes with unique molecular characteristics. Genes, which we can sequence with great accuracy using the tools of precision medicine, tell us a lot about two factors that help determine successful treatment. They tell us what genes are abnormal and “driving” the cancer; they also tell us how our individual bodies metabolize and react to drugs.
Precision medicine, also known as “personalized medicine” or “targeted therapy,” is a model that allows us to tailor treatment based upon the molecular profile of a patient’s tumor. It also allows us to develop and use diagnostic tests to better predict who is at risk for certain diseases based on genetics. This could lead to unprecedented ways of preventing genetic diseases.
Thanks to the Human Genome Project and technological advances, we sense that our fierce ambition to bring cancer under control finally lines up with our ability to do so. In the past decade alone, we’ve developed the ability to molecularly profile multiple cancer subtypes and match them with new therapies.
We’ve made significant progress on some fronts but remain far from achieving the promise of President Nixon’s 1971 National Cancer Act declaring war on cancer. Nearly 1.6 million Americans will be diagnosed with cancer this year, and 586,000 will die from it. By 2020, cancer will overtake heart disease as the leading cause of death in the United States.
That’s why the precision medicine initiative is critical. The time to invest in precision medicine is now. A key provision of the President’s initiative that must be preserved in the final bill is that the precision medicine resources do not drain the already-shrinking research funds for medical science. This must be new money—not simply a reallocation.
Precision medicine is one of the most exciting and promising frontiers in cancer treatment, and the President’s initiative is worthy of support. It is an exciting time to be working in cancer research and treatment. We fully intend to harness everything within our reach—and just beyond it—to make it more hopeful to be a patient.