Cancer: Personalized Medicine

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Regardless of whether you use the term Personalized or Individualized Medicine, or what the NCI director Harold Varmus likes to call, “genetically informed medicine”, the idea that we must start thinking about each person who has cancer as his/her own self and not as a group, has certainly caught on.

Most cancer drugs have been tested in multi million dollar clinical trials studies by large pharmaceutical companies (few other can afford them).  The limitation (and there are many) is that these studies look at testing new anti cancer drugs using a large and randomized mixed populations.  It is probably no surprise then when you realize that the effectiveness of novel anti cancer therapies are around 30%.  Or, another way to look at this is that high failure rates of on average of 70% are seen as these drugs can not account in any way for how individuals respond. 

So, cancer therapies rely on the traditional standard three forms of therapy and a very limited set of targeted anti-cancer drugs that are pretty weak in the overall population.  The second large problem is that in hospitals all over the country (US) as well as internationally, oncologists are mixing and matching their patients with these new drugs in their own ways.  In essence, creating their own mini clinical trials one patient at time.  These oncologists do look for improved clinical responses and do try to publish these findings.  However, due to limited resources and the nature of powerful drug trials, these ‘small’ publications and case reports are often ignored.  One must have thousands of small case reports that show the same thing across the world before anyone would listen or take note. 

So, there is a disconnect between the efforts that the pharmaceutical industry is doing and publishing and what is actually being done on the ground in hospitals.  Pharmaceutical companies are selling their drugs and designing their studies to treat everyone who has a particular cancer at a certain stage with certain designated prior failures to therapy (or newly diagnosed in some cases).  While, clinicians are treating their patients one at a time, as they should be.  It is the N of ‘1’ trail versus the four stage clinical trials involving thousands of dollars. 

The good news is that 1) pharmaceutical companies know this and are spending millions to acquire tools to look at individuals’ genetics and compare them to responsiveness of a particular drug, 2) the N of 1 experiments when done properly are gaining ground and acceptance, and 3) there are companies such as Cancer Commons (http://cancercommons.com/) that are encouraging oncologists to start reporting their ‘in-house’ results in order to get more and more data from ‘individualized’ treatments throughout the US and elsewhere.

So, things look promising, but it’s going to take some time before we can say we are treating the patient before us and not all patients before us.

Thanks,

Dr. C

For more information….please see Cancer Made Simple

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