June 5, 2011

USA: Cancer’s New Era Of Promise And Chaos

NEW YORK, NY / Forbes.com / June 5, 2011

THE MEDICINE SHOW
By Matthew Herper

In a major speech to cancer doctors Saturday, the outgoing president of the American Society of Clinical Oncology told his colleagues to prepare for a new era in which rapidly advancing genetic technology will change the way cancer is treated for the better – but also force doctors to change the way they invent and test drugs and care for patients.

This bold declaration came as the first results of this way of thinking bear fruit. A drug made by pharmaceutical giants Roche and Daiichi Sankyo reduces the risk of death from melanoma by 63% – if the skin cancer tumor has a particular mutation. A Pfizer lung cancer treatment awaiting regulatory approval keeps lung cancer patients alive longer – if they are in the small minority that have a very specific genetic defect. Two clinical trials that have been presented at ASCO ‘s annual meeting in Chicago, which I’m attending, showed it is possible to pick drugs for patients using a panel of genetic tests. Image via Wikipedia

George Sledge, the ASCO president and one of the country’s top breast cancer researchers dramatically and eloquently spelled out what these big changes will mean. This story is a condensation of his prepared remarks, which ASCO shared with me. Mistakes are mine. Credit for marshaling these facts and constructing this argument belongs to Sledge.

Cancer doctors, Sledge said, are entering an era of “genomic chaos,” a phrase that describes both the genetic madness that makes healthy cells turn into deadly cancers and the instability that incorporating rapidly advancing genetic technology into cancer care will bring. The way clincial trials are run will need to change dramatically. New kinds of electronic health records will need to be created to collect data, inform doctors instantly of new results, and track how good a job physicians are doing. Sledge, whose one-year term as ASCO president is ending, argued doctors need to face up to this blast of new technology.

Dr. Sledge's  Presidential Address at the Annual Meeting. Photo by © GMG/Todd Buchanan 2011.

This is not just geeky talk about cool genetics — it is really a matter of life and death. The speech was dedicated to Sledge’s administrative assistant, who was recently diagnosed with triple-negative breast cancer, one of the hardest varieties of the disease to treat.

A million and a half Americans will be diagnosed with cancer this year, Sledge said. Cancer death rates are falling as a result of less tobacco smoking and better science, but malignancy kills half a million Americans every year. The cost of health care outpaces inflation. According to an article in the Journal of National Cancer Institute, costs for cancer care will increase by 27% or more. The workforce of doctors willing to do clinical trials is dropping; it is hard work, comparatively poorly compensated, and is a “labor of love.” And new cancer drugs fail most of the time. Cancer drugs succeed in late-stage trials 34% of the time, compared to the 60% success rate in respiratory disease, endocrinology, and immune system disorders.

Doctors have been trying to use localized treatments to attack tumors since the 19th century. In the 1940s and early 1950s, the first chemotherapies were used. Cancer drugs like Gleevec and Erbitux, targeted to attack specific mutations in cancer cells, have been the breakthroughs of the past decade. The next step, Sledge says, is DNA-sequencing technology, which is getting cheaper and more powerful at a rate faster than Moore’s Law, which predicts the regular reduction in the cost of microprocessors that has driven the computer revolution. Already, he notes, companies like Knome in Cambridge, Mass., will deliver a genome on a thumb drive.

“So what happens when, a few years from now, a patient walks into a doctor’s office and hands a physician a memory stick loaded with gigabytes of personal genomic data?” Sledge asks. His answer: the flood of data will help doctors and patients, but things will get “very, very complicated.”

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