Genetics may be useful in identifying subpopulations of patients most likely to benefit from a particular drug
- From: J <macyinno@xxxxxxxxxx>
- Date: Thu, 10 Aug 2006 06:05:48 -0400
<http://www.boston.com/news/nation/articles/2006/08/10/genetic_test_aids_lung_cancer_fight/>
Genetic test aids lung cancer fight
Helps physicians choose treatment
By Gareth Cook, Globe Staff | August 10, 2006
Scientists have developed a powerful new genetic test to determine which
lung cancer patients should get chemotherapy, saying the advance could
save thousands of lives every year and heralds the growing importance of
genetic profiling in cancer care.
Patients whose lung cancer is caught at the earliest stage typically do
not get chemotherapy, because the benefits outweigh the toxic side effects
of the drugs only for a subset of patients likely to suffer a recurrence.
The new test allows doctors for the first time to identify which patients
are at greatest risk for a recurrence -- an almost certain death sentence
-- and then give them chemotherapy.
The results, described in today's issue of the New England Journal of
Medicine, are so promising that researchers are launching a broad,
government-funded clinical trial of the test within the next six months,
including some 1,200 patients at about 60 sites in the United States and
Canada.
The new test is welcome news for the treatment of lung cancer, which kills
more Americans than any other cancer. Researchers also said it is a sign
that a much-anticipated transformation in cancer treatment is gathering
momentum. Using new genetic tools, doctors are learning how to measure the
characteristics of a particular patient's tumor and use this information
to mount a more effective counterattack. This ``personalized medicine" is
already saving lives of patients with breast cancer and leukemia, and the
list of diseases is now expected to grow. Similar tests are being
developed for colon, prostate , and other cancers.
``I think this is a very, very exciting tool," said Dr. Tom Lynch ,
director of the Center for Thoracic Cancers at Massachusetts General
Hospital. ``The future of cancer therapy is going to be based on exactly
what this paper is about."
One of the great frustrations of cancer medicine is that tumors that look
the same do not always act the same, leaving doctors unsure how to treat
patients. Now, scientists are learning to distinguish cancers by the
genetic machinery at work in the tumors, paving the way for more effective
therapies. Some tumors may have distinctive mutations in their DNA. For
example, some breast cancer tumors have a mutation that leads them to
produce an excess of a protein called ``HER2," and women with these
aggressive tumors are being successfully treated with a drug called
Herceptin.
Tumors may also have telltale patterns of genes that are active. At any
given moment, some genes in a tumor are turned on, making proteins, and
others are turned off. Identifying the ``on" genes is known as measuring
``gene expression," and this is the method used in the lung cancer study,
which was led by scientists at Duke
August 10, 2006
Scientists have developed a powerful new genetic test to determine which
lung cancer patients should get chemotherapy, saying the advance could
save thousands of lives every year and heralds the growing importance of
genetic profiling in cancer care.
Patients whose lung cancer is caught at the earliest stage typically do
not get chemotherapy, because the benefits outweigh the toxic side effects
of the drugs only for a subset of patients likely to suffer a recurrence.
The new test allows doctors for the first time to identify which patients
are at greatest risk for a recurrence -- an almost certain death sentence
-- and then give them chemotherapy.
The results, described in today's issue of the New England Journal of
Medicine, are so promising that researchers are launching a broad,
government-funded clinical trial of the test within the next six months,
including some 1,200 patients at about 60 sites in the United States and
Canada.
The new test is welcome news for the treatment of lung cancer, which kills
more Americans than any other cancer. Researchers also said it is a sign
that a much-anticipated transformation in cancer treatment is gathering
momentum. Using new genetic tools, doctors are learning how to measure the
characteristics of a particular patient's tumor and use this information
to mount a more effective counterattack. This ``personalized medicine" is
already saving lives of patients with breast cancer and leukemia, and the
list of diseases is now expected to grow. Similar tests are being
developed for colon, prostate , and other cancers.
``I think this is a very, very exciting tool," said Dr. Tom Lynch ,
director of the Center for Thoracic Cancers at Massachusetts General
Hospital. ``The future of cancer therapy is going to be based on exactly
what this paper is about."
One of the great frustrations of cancer medicine is that tumors that look
the same do not always act the same, leaving doctors unsure how to treat
patients. Now, scientists are learning to distinguish cancers by the
genetic machinery at work in the tumors, paving the way for more effective
therapies. Some tumors may have distinctive mutations in their DNA. For
example, some breast cancer tumors have a mutation that leads them to
produce an excess of a protein called ``HER2," and women with these
aggressive tumors are being successfully treated with a drug called
Herceptin.
Tumors may also have telltale patterns of genes that are active. At any
given moment, some genes in a tumor are turned on, making proteins, and
others are turned off. Identifying the ``on" genes is known as measuring
``gene expression," and this is the method used in the lung cancer study,
which was led by scientists at Duke University.
Page 2 of 2 --
The scientists at Duke identified patterns of active genes typical of more
lethal tumors. The work could provide pharmaceutical companies clues that
will help develop drugs and help scientists understand the disease's inner
workings, according to Tyler Jacks , a lung cancer researcher who is also
director of the MIT Center for Cancer Research.
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The test could also have broad clinical applications, according to Dr.
Anil Potti , who led the study and is an assistant professor at Duke.
Initially, it will be used to identify patients with stage 1 non-small
cell lung cancer, a common form of the disease, who would benefit from
chemotherapy. The team also hopes to identify patients with later stages
of the disease who are unlikely to benefit from chemotherapy, saving them
the rigors of the drugs.
And, Potti said, the team has early data that suggest the same genetic
tools can identify which chemotherapy drug will work best on which
patient's tumors. This would represent another important advance and could
also have applications in the treatment of breast cancer, where doctors
use some of the same chemotherapy drugs, he said.
Between 40,000 and 45,000 patients are diagnosed with stage 1 non-small
cell lung cancer every year in North America, Potti said. Typically, a
surgeon will remove the tumor, but the patient is not given chemotherapy.
Between 40 percent and 50 percent of patients will have a recurrence, and
virtually all of these patients die. Preventing even some of these deaths
would mean thousands of lives saved every year, Potti said.
The team analyzed samples of tumors from patients who had a recurrence and
those who were cancer-free for five years, according to the journal
article. The team discovered they could distinguish between the two groups
based on patterns of activity in groups of genes. These patterns serve as
a kind of fingerprint.
The team then used their test in three groups of patients and found that
they were able to predict whose cancers would recur between 72 percent and
81 percent of the time.
There is currently a test, offered by California-based Genomic Health ,
that uses gene expression to predict the risk of recurrence in breast
cancer. In June, the company said that early data showed that the same
thing could be done with colon cancer.
As the research moves forward, it could also improve the process of
developing cancer drugs, according to Dr. Todd Golub, director of the
Cancer Project at the Broad Institute of Harvard and MIT. Genetics can be
used to identify subpopulations of patients most likely to benefit from a
particular drug ahead of time, meaning that clinical trials could be
smaller, less expensive, and more likely to succeed, Golub said.
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