The Age of Genomics by Ken Burger

  • Wednesday, November 6, 2013

Ken Burger

When you're in a war, you need a secret weapon because the enemy is constantly changing. In the war on cancer, patients have routinely been submitted to the “shotgun approach,” and we've seen the results. Heavy doses of chemotherapy take a serious toll on the body in hopes of hitting the desired target. Patients are stripped of their hair, energy, dignity, and then they throw up, again. Cancer, as you know, has a nasty habit of retreating, only to come back with a slightly different appearance, albeit the same evil intent. That's where we've been losing the war.  But with the unraveling of the human genome, doctors are now able to isolate specific genes within cancer tumors that are associated with aggressiveness or responsiveness, the keys to prognosis and predictability. “It's a game changer,” says Dr. Rick McEvoy, a pathologist with Roper St. Francis. “It's changing outcomes. Oncologists across the U.S. have seen dramatic tumor shrinkage over months and years.”

Personalized Medicine

This new technology is the result of scientists working for years to identify more than 33,000 genes that make up the human DNA. Then, with even more intensive study, scientists targeted 50 specific genes that relate to cancer tumors. This technology has allowed for a collaborative relationship between the laboratory, the healthcare system and oncologists treating patients with cancer. “This is called next-generation sequencing,” McEvoy said. “It's an outgrowth of the umbrella term of personalized medicine. It allows physicians to better interpret laboratory work and biopsy results, and it has grown into more specialized testing to help develop a treatment strategy.” McEvoy said this has translated into fantastic results in cardiology, where medications are prepared to lower blood pressure, lower cholesterol or better thin the blood based on enzymes in the patient's body.“What we're trying to do is look at the patient's tumor,” he said. “We're asking if the tumor harbors changes that may make one medication or a group of medications markedly effective.”

Molecular Pathology

McEvoy said the “shotgun vs. laser” comparison of treatments is a fair one.“We're taking what has been the general standard of care for a specific tumor for a long period of time that has had both successes and failures for the patient, and weeding out 'why was this successful and why was this not successful.'” To accomplish this, scientists isolate the DNA of the tumor, then sequence 50 genes that are associated with tumor aggressiveness. These 50 genes have been determined to be responsible for prognosis, also known as “driver mutations.” And, this is not a static process. “It is modifiable over time, meaning it is a dynamic process that can be changed as the tumor changes and new inhibitors are developed,” McEvoy said. This molecular pathology is not something in the far-away future. It's being done at a few places around the U.S., and with the commitment of the Roper St. Francis Cancer Care, it is here. Contact Ken at ken.burger@rsfh.com

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