THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING

Push on to tailor cancer care

Rush of research pointing the way

By Lauran Neergaard
Associated Press / February 17, 2009
  • Email|
  • Print|
  • Single Page|
  • |
Text size +

WASHINGTON - The days of one-size-fits-all cancer treatment are numbered: A rush of new research is pointing the way to tailor chemotherapy and other care to what's written in your tumor's genes.

Everyone with advanced colon cancer now is supposed to get a genetic test before taking two of the leading treatments. It's a major change adopted by oncologists last month after studies found that those pricey drugs, Erbitux and Vectibix, won't work in 40 percent of patients.

Scientists are furiously testing similar genetically tailored care in breast and lung cancer. The flurry of work reflects a huge problem: Most medications today benefit at best about half of patients, but it usually takes trial-and-error to tell.

That means a lot of people suffer side effects for nothing, and it is incredibly costly. When the American Society of Clinical Oncology recommended giving colon cancer patients that $300 test for a gene called KRAS, it estimated the move could save a stunning $600 million a year - by keeping drugs that cost up to $10,000 a month away from patients who would not benefit.

As tantalizing as this personalized medicine is, gene testing is like the Wild West. Laboratories often introduce new tests at the first clues they might work. Few tests so far have won the backing of major medical groups, making research studies a best bet for many patients.

This is not about testing if people carry cancer genes that make them prone to illness. Instead it's about finding a tumor's genetic signature - a pattern of gene and protein activity that signals if the cancer will grow fast or slowly, be more or less likely to recur, and whether it would be susceptible to treatment.

"We're getting into science fiction sort of, if now medicine is being able to analyze things at the genome level," breast cancer patient Claire Weinberg of Oxford, N.C., said.

Under study:

  • A less precise test already can tell certain breast cancer patients if they're at high or low risk of relapsing, helping the chemo-or-not decision. But which chemo? Duke's Dr. Kelly Marcom is genetically profiling breast biopsy tissue from nearly 300 newly diagnosed patients headed for presurgery chemo. Some are randomly assigned to one of two standard chemotherapy cockails; the rest get the cocktail that matches their tumor profile.

  • Instead of custom profiling, an experimental test unveiled last week examines 50 breast cancer genes to determine which of four disease subtypes the woman has. If it pans out the Breast Bioclassifier could change breast cancer's very names. When studied on stored samples of old tumors, researchers found some women safely skipped chemo. A more aggressive type was sensitive to most chemo choices but not hormone treatment.

  • Next up, lung cancer. Hospitals nationwide are recruiting 1,200 lung cancer patients to study who carries extra copies of the gene EGFR. They'll get either of two top treatments, Tarceva or Alimta, to see which is best for which condition.

    • Email
    • Email
    • Print
    • Print
    • Single page
    • Single page
    • Reprints
    • Reprints
    • Share
    • Share
    • Comment
    • Comment
     
    • Share on DiggShare on Digg
    • Tag with Del.icio.us Save this article
    • powered by Del.icio.us
    Your Name Your e-mail address (for return address purposes) E-mail address of recipients (separate multiple addresses with commas) Name and both e-mail fields are required.
    Message (optional)
    Disclaimer: Boston.com does not share this information or keep it permanently, as it is for the sole purpose of sending this one time e-mail.