To Outsmart Cancer
Mysteries surrounding cancer genomics have been stripped away in recent years, exposing the disease as a target for precision medicine. Discoveries asked Monica Mita, MD, co-director of Experimental Therapeutics at Cedars-Sinai, to explain how oncology research stands to gain ground in the near future.
Q. What makes cancer genetically interesting?
A. Cancer is genetically diverse, even within a single tumor or among patients with the same type of cancer. Its genetics change over time, and there simply isn’t one single treatment for everybody. So we have to outsmart it.
Q. How is cancer vulnerable to attack?
A. Very simply, cancer cells are abnormal because of gene mutation or variation in how genes are expressed. We have learned that treatments often affect certain targets: If we target the abnormal gene that drives the cancer growth, in some cases, we can kill the disease.
Q. Is that precision medicine?
A. Yes. Every cancer is different, every mutation is different, and we have to find the mutation before we can target it. We want to know what is happening inside every person’s cancer in order to choose a treatment that is targeted for that individual. That is precision medicine.
Q. Where are we today with developing targeted treatments for cancer?
A. Imatinib (also known as Gleevec) is the classic example of a targeted treatment that changed cancer research. It was developed to treat chronic myelogenous leukemia [CML]. [Prior to approval of the drug in 2001, less than one in three CML patients survived five years past diagnosis.] Today, 90 percent of CML patients can achieve remission with Gleevec. Since then, we have developed many other targeted therapies. Still, many more are needed, and we need to learn how to combine them for enhanced anticancer activity.
Q. Can precision medicine be used to enhance a patient’s own immune system through immunotherapy?
A. I think a revolution in immunotherapy is beginning. A patient might receive antibodies to help the immune system to attack a tumor, but not every person’s immune system will respond the same way, and not every tumor will be vulnerable. We are studying why the response varies so we can personalize therapy.
Q. How else can precision medicine help outsmart cancer?
A. When we create genetic or molecular profiles for a tumor and then try to match the patient with the best treatment, we do it patient by patient. We need a huge database that is of national or international scope so we can correlate many different molecular profiles with outcomes. Precision medicine also helps us determine who are the best candidates for surgery.
Q. What can patients do to help cancer research?
A. In the U.S., less than 5 percent of adult patients are enrolled in clinical trials. If we could increase that to 20 percent, we would achieve results faster and help more people.
This interview has been edited and condensed.