1
|
Personalised Medicine: The Odyssey from Hope to Practice. J Pers Med 2018; 8:jpm8040031. [PMID: 30248964 PMCID: PMC6313378 DOI: 10.3390/jpm8040031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 01/08/2023] Open
Abstract
In this endeavour, inspired by the Odyssey, we aim to embark with the reader on a journey on a ship from Troy to Ithaca, coursing through the history of the momentous events and achievements that paved the way for personalised medicine. We will set sail amidst important genetic discoveries, beginning with the discovery of the first human genome, and voyage through the projects that contributed to the progress of pharmacogenomic studies. Concurrently, we will propose methods to overcome the obstacles that are slowing the potential full implementation of accumulated knowledge into everyday practice. This journey aims to reflect on the frontiers of current genetic knowledge and the practical use of this knowledge in preventive, diagnostic and pharmacogenomic approaches to directly impact the socio-economic aspects of public health.
Collapse
|
2
|
Sureda M, Rebollo J, Martínez-Navarro EM, Fernández-Morejón FJ, Farré J, Muñoz V, Bretcha-Boix P, Duarte M, Manzano RG, Crespo A, Del Carmen Redal M, Valenzuela B, Brugarolas A. Determining personalized treatment by gene expression profiling in metastatic breast carcinoma patients: a pilot study. Clin Transl Oncol 2018; 20:785-793. [PMID: 29159791 DOI: 10.1007/s12094-017-1789-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/26/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study evaluates the massive study of gene expression in metastatic breast carcinoma (MBC) patients using microarray gene expression profiling (MAGE) complemented with conventional sequencing, immunohistochemistry (IHC) and fluorescent "in situ" hybridization (FISH), seeking to optimize the treatment in a subset of heavily pretreated patients and with limited life expectancy. PATIENTS, MATERIAL AND METHODS MBC patients in hormone therapy progression with survival expectancy of at least 3 months (m) have been included. The MAGE contains gene probes representing genes known to potentially interact with available drugs as cited in the literature. RESULTS Thirty-nine procedures were performed from October 2010 to April 2016. Within the 30 evaluable procedures, considering all hormonal manipulations as a single line, the patients had received a median of 4 treatment lines prior to MAGE (range 1-7). Progression was observed in 6 cases, stable disease (SD) in 7 cases and partial response (PR) in 16 cases, which implies a clinical benefit rate (SD + PR) of 76%. Actuarial median progression-free survival (PFS) was 6 m (95% CI 2.5-9.5) in patients with clinical benefit. The median overall survival (OS) for the entire series was 11 m (95% CI 2.2-19.8). CONCLUSION Data presented here indicate that the use of MAGE provides relevant information to establish personalized treatment in frail patients with limited life expectancy in which therapeutic futility is a particularly difficult burden to assume.
Collapse
Affiliation(s)
- M Sureda
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain. .,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain.
| | - J Rebollo
- Servicio Oncología Médica, Hospital General de Villalba, Collado Villalba, Madrid, Spain
| | - E Mª Martínez-Navarro
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - F J Fernández-Morejón
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - J Farré
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - V Muñoz
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - P Bretcha-Boix
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - M Duarte
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - R G Manzano
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - A Crespo
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - M Del Carmen Redal
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - B Valenzuela
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - A Brugarolas
- Plataforma de Oncología-Fundación TEDECA, Hospital Quironsalud Torrevieja, Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.,Cátedra de Oncología Multidisciplinar, Universidad Católica de Murcia (UCAM), Murcia, Spain
| |
Collapse
|
3
|
Cassel JB, Del Fabbro E, Arkenau T, Higginson IJ, Hurst S, Jansen LA, Poklepovic A, Rid A, Rodón J, Strasser F, Miller FG. Phase I Cancer Trials and Palliative Care: Antagonism, Irrelevance, or Synergy? J Pain Symptom Manage 2016; 52:437-45. [PMID: 27233136 DOI: 10.1016/j.jpainsymman.2016.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/06/2016] [Accepted: 02/26/2016] [Indexed: 12/19/2022]
Abstract
This article synthesizes the presentations and conclusions of an international symposium on Phase 1 oncology trials, palliative care, and ethics held in 2014. The purpose of the symposium was to discuss the intersection of three independent trends that unfolded in the past decade. First, large-scale reviews of hundreds of Phase I trials have indicated there is a relatively low risk of serious harm and some prospect of clinical benefit that can be meaningful to patients. Second, changes in the design and analysis of Phase I trials, the introduction of "targeted" investigational agents that are generally less toxic, and an increase in Phase I trials that combine two or more agents in a novel way have changed the conduct of these trials and decreased fears and apprehensions about participation. Third, the field of palliative care in cancer has expanded greatly, offering symptom management to late-stage cancer patients, and demonstrated that it is not mutually exclusive with disease-targeted therapies or clinical research. Opportunities for collaboration and further research at the intersection of Phase 1 oncology trials and palliative care are highlighted.
Collapse
Affiliation(s)
- J Brian Cassel
- Virginia Commonwealth University, Richmond, Virginia, USA.
| | | | - Tobias Arkenau
- Sarah Cannon Research Institute and University College London, London, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Samia Hurst
- Institut d'éthique biomedicale, Centre médical universitaire, Geneva, Switzerland
| | - Lynn A Jansen
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Annette Rid
- King's College London, London, United Kingdom
| | - Jordi Rodón
- Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | | | | |
Collapse
|
4
|
De Mattos-Arruda L, Shen R, Reis-Filho JS, Cortés J. Translating neoadjuvant therapy into survival benefits: one size does not fit all. Nat Rev Clin Oncol 2016; 13:566-79. [PMID: 27000962 DOI: 10.1038/nrclinonc.2016.35] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neoadjuvant therapy has been established as an effective therapeutic approach for patients with locally advanced breast cancer. Similar outcomes between neoadjuvant and adjuvant chemotherapy have been demonstrated in several trials. Nevertheless, neoadjuvant therapy has some advantages over adjuvant therapy, including tumour downstaging, in vivo assessment of therapeutic efficacy, reduced treatment durations, and the need to enrol fewer patients for clinical trials to reach their preplanned objectives. The number of neoadjuvant trials in patients with breast cancer has increased substantially in the past 5 years, particularly in the context of HER2-positive disease. Substantial improvements in the pathological complete response rate to anti-HER2 therapy, a proposed surrogate end point for long-term clinical benefit, have been observed with neoadjuvant dual-agent HER2 blockade. Thus, it was hypothesized that this approach would provide additional survival benefits over standard-of-care therapy with the anti-HER2 antibody trastuzumab in the adjuvant setting. Emerging data, however, are calling this notion into question. We discuss potential reasons why results of neoadjuvant trials of targeted therapies have not been mirrored in the adjuvant setting, and other than inherent differences in clinical-trial designs and statistical power, we consider how the biology of the disease, patient characteristics, and drug administration and schedule might influence the results.
Collapse
Affiliation(s)
- Leticia De Mattos-Arruda
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Campus de la UAB, Plaza Cívica, 08193 Bellaterra, Barcelona, Spain
| | - Ronglai Shen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
| | - Javier Cortés
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Ramon y Cajal University Hospital, Ctra. de Colmenar Viejo, 28034 Madrid, Spain.,Medica Scientia Innovation Research (MedSIR), C/ Rambla Catalunya 2, 2D, 08007 Barcelona, Spain
| |
Collapse
|
5
|
De Mattos-Arruda L, Caldas C. Cell-free circulating tumour DNA as a liquid biopsy in breast cancer. Mol Oncol 2016; 10:464-74. [PMID: 26776681 PMCID: PMC5528975 DOI: 10.1016/j.molonc.2015.12.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022] Open
Abstract
Recent developments in massively parallel sequencing and digital genomic techniques support the clinical validity of cell-free circulating tumour DNA (ctDNA) as a 'liquid biopsy' in human cancer. In breast cancer, ctDNA detected in plasma can be used to non-invasively scan tumour genomes and quantify tumour burden. The applications for ctDNA in plasma include identifying actionable genomic alterations, monitoring treatment responses, unravelling therapeutic resistance, and potentially detecting disease progression before clinical and radiological confirmation. ctDNA may be used to characterise tumour heterogeneity and metastasis-specific mutations providing information to adapt the therapeutic management of patients. In this article, we review the current status of ctDNA as a 'liquid biopsy' in breast cancer.
Collapse
Affiliation(s)
- Leticia De Mattos-Arruda
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK; Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK; Department of Oncology, University of Cambridge, Cambridge, UK; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| |
Collapse
|
6
|
Taylor DA, Perin EC, Willerson JT, Zierold C, Resende M, Carlson M, Nestor B, Wise E, Orozco A, Pepine CJ, Henry TD, Ellis SG, Zhao DXM, Traverse JH, Cooke JP, Schutt RC, Bhatnagar A, Grant MB, Lai D, Johnstone BH, Sayre SL, Moyé L, Ebert RF, Bolli R, Simari RD, Cogle CR. Identification of Bone Marrow Cell Subpopulations Associated With Improved Functional Outcomes in Patients With Chronic Left Ventricular Dysfunction: An Embedded Cohort Evaluation of the FOCUS-CCTRN Trial. Cell Transplant 2015; 25:1675-1687. [PMID: 26590374 PMCID: PMC5088500 DOI: 10.3727/096368915x689901] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In the current study, we sought to identify bone marrow-derived mononuclear cell (BM-MNC) subpopulations associated with a combined improvement in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and maximal oxygen consumption (VO2 max) in patients with chronic ischemic cardiomyopathy 6 months after receiving transendocardial injections of autologous BM-MNCs or placebo. For this prospectively planned analysis, we conducted an embedded cohort study comprising 78 patients from the FOCUS-Cardiovascular Cell Therapy Research Network (CCTRN) trial. Baseline BM-MNC immunophenotypes and progenitor cell activity were determined by flow cytometry and colony-forming assays, respectively. Previously stable patients who demonstrated improvement in LVEF, LVESV, and VO2 max during the 6-month course of the FOCUS-CCTRN study (group 1, n = 17) were compared to those who showed no change or worsened in one to three of these endpoints (group 2, n = 61) and to a subset of patients from group 2 who declined in all three functional endpoints (group 2A, n = 11). Group 1 had higher frequencies of B-cell and CXCR4+ BM-MNC subpopulations at study baseline than group 2 or 2A. Furthermore, patients in group 1 had fewer endothelial colony-forming cells and monocytes/macrophages in their bone marrow than those in group 2A. To our knowledge, this is the first study to show that in patients with ischemic cardiomyopathy, certain bone marrow-derived cell subsets are associated with improvement in LVEF, LVESV, and VO2 max at 6 months. These results suggest that the presence of both progenitor and immune cell populations in the bone marrow may influence the natural history of chronic ischemic cardiomyopathy-even in stable patients. Thus, it may be important to consider the bone marrow composition and associated regenerative capacity of patients when assigning them to treatment groups and evaluating the results of cell therapy trials.
Collapse
Affiliation(s)
- Doris A. Taylor
- Texas Heart Institute, CHI St. Luke’s Health, Houston, TX, USA
| | | | | | - Claudia Zierold
- University of Minnesota School of Medicine, Minneapolis, MN, USA
| | | | - Marjorie Carlson
- University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Belinda Nestor
- Texas Heart Institute, CHI St. Luke’s Health, Houston, TX, USA
| | - Elizabeth Wise
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Aaron Orozco
- Texas Heart Institute, CHI St. Luke’s Health, Houston, TX, USA
| | - Carl J. Pepine
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Timothy D. Henry
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
- Minneapolis Heart Institute Foundation at Abbott, Minneapolis, MN, USA
| | | | | | - Jay H. Traverse
- Minneapolis Heart Institute Foundation at Abbott, Minneapolis, MN, USA
| | - John P. Cooke
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Houston Methodist Research Institute, Houston, TX, USA
| | - Robert C. Schutt
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Houston Methodist Research Institute, Houston, TX, USA
| | | | - Maria B. Grant
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Dejian Lai
- University of Texas School of Public Health, Houston, TX, USA
| | | | - Shelly L. Sayre
- University of Texas School of Public Health, Houston, TX, USA
| | - Lem Moyé
- University of Texas School of Public Health, Houston, TX, USA
| | - Ray F. Ebert
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | | | | |
Collapse
|
7
|
Loaiza-Bonilla A, Furth EE, Morrissette JJD. Next-generation sequencing and personalized genomic medicine in hepatobiliary malignancies. Hepat Oncol 2015; 2:359-370. [PMID: 30191018 PMCID: PMC6095428 DOI: 10.2217/hep.15.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Liver cancer is a heterogeneous group of tumors characterized by significant molecular and genomic heterogeneity. The advent of powerful genomic technologies has allowed detection of recurrent somatic alterations in liver cancer, including mutations, copy number alterations as well as changes in transcriptomes and epigenomes, with the potential to translate these data into clinically relevant predictive and prognostic factors. In this review, we discuss recent advances in the application of high-throughput genomic technologies in liver cancer and the integration of such cancer genome profiling data, highlighting specific relevant subgroups and explain how this knowledge can be used in translational clinical research, 'basket trials', molecular tumor boards, targeted therapy and for personalized genomic medicine applications.
Collapse
Affiliation(s)
- Arturo Loaiza-Bonilla
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Emma E Furth
- Department of Pathology & Laboratory Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jennifer JD Morrissette
- Department of Pathology & Laboratory Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| |
Collapse
|
8
|
Meißner T, Fisch KM, Gioia L, Su AI. OncoRep: an n-of-1 reporting tool to support genome-guided treatment for breast cancer patients using RNA-sequencing. BMC Med Genomics 2015; 8:24. [PMID: 25989980 PMCID: PMC4494802 DOI: 10.1186/s12920-015-0095-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/30/2015] [Indexed: 01/30/2023] Open
Abstract
Background Breast cancer comprises multiple tumor entities associated with different biological features and clinical behaviors, making individualized medicine a powerful tool to bring the right drug to the right patient. Next generation sequencing of RNA (RNA-Seq) is a suitable method to detect targets for individualized treatment. Challenges that arise are i) preprocessing and analyzing RNA-Seq data in the n-of-1 setting, ii) extracting clinically relevant and actionable targets from complex data, iii) integrating drug databases, and iv) reporting results to clinicians in a timely and understandable manner. Results To address these challenges, we present OncoRep, an RNA-Seq based n-of-1 reporting tool for breast cancer patients. It reports molecular classification, altered genes and pathways, gene fusions, clinically actionable mutations and drug recommendations. It visualizes the data in an approachable html-based interactive report and a PDF clinical report, providing the clinician and tumor board with a tool to guide the treatment decision making process. Conclusions OncoRep is free and open-source (https://bitbucket.org/sulab/oncorep/), thereby offering a platform for future development and innovation by the community.
Collapse
Affiliation(s)
- Tobias Meißner
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, 92037, CA, USA.
| | - Kathleen M Fisch
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, 92037, CA, USA.
| | - Louis Gioia
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, 92037, CA, USA.
| | - Andrew I Su
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, 92037, CA, USA.
| |
Collapse
|
9
|
Rodon J, Soria JC, Berger R, Batist G, Tsimberidou A, Bresson C, Lee JJ, Rubin E, Onn A, Schilsky RL, Miller WH, Eggermont AM, Mendelsohn J, Lazar V, Kurzrock R. Challenges in initiating and conducting personalized cancer therapy trials: perspectives from WINTHER, a Worldwide Innovative Network (WIN) Consortium trial. Ann Oncol 2015; 26:1791-8. [PMID: 25908602 DOI: 10.1093/annonc/mdv191] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/13/2015] [Indexed: 12/11/2022] Open
Abstract
Advances in 'omics' technology and targeted therapeutic molecules are together driving the incorporation of molecular-based diagnostics into the care of patients with cancer. There is an urgent need to assess the efficacy of therapy determined by molecular matching of patients with particular targeted therapies. WINTHER is a clinical trial that uses cutting edge genomic and transcriptomic assays to guide treatment decisions. Through the lens of this ambitious multinational trial (five countries, six sites) coordinated by the Worldwide Innovative Networking Consortium for personalized cancer therapy, we discovered key challenges in initiation and conduct of a prospective, omically driven study. To date, the time from study concept to activation has varied between 19 months at Gustave Roussy Cancer Campus in France to 30 months at the Segal Cancer Center, McGill University (Canada). It took 3+ years to be able to activate US sites due to national regulatory hurdles. Access to medications proposed by the molecular analysis remains a major challenge, since their availability through active clinical trials is highly variable over time within sites and across the network. Rules regarding the off-label use of drugs, or drugs not yet approved at all in some countries, pose a further challenge, and many biopharmaceutical companies lack a simple internal mechanism to supply the drugs even if they wish to do so. These various obstacles should be addressed to test and then implement precision medicine in cancer.
Collapse
Affiliation(s)
- J Rodon
- Vall D'Hebron Institute of Oncology and Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J C Soria
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - R Berger
- Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - G Batist
- Segal Cancer Center, Jewish General Hospital Mcgill University, Montreal Quebec Consortium de Recherche en Oncologie Clinique, Quebec, Canada
| | - A Tsimberidou
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - J J Lee
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E Rubin
- The National Institute of Biotechnology in the Negev, Ben Gurion University, Beer-Sheva, Israel
| | - A Onn
- Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - R L Schilsky
- American Society of Clinical Oncology (ASCO), Alexandria
| | - W H Miller
- Segal Cancer Center, Jewish General Hospital Mcgill University, Montreal Quebec Consortium de Recherche en Oncologie Clinique, Quebec, Canada
| | - A M Eggermont
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - J Mendelsohn
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - V Lazar
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - R Kurzrock
- Center for Personalized Cancer Therapy, UC San Diego-Moores Cancer Center, La Jolla, USA
| |
Collapse
|
10
|
Towards real-time 3D ultrasound planning and personalized 3D printing for breast HDR brachytherapy treatment. Radiother Oncol 2015; 114:335-8. [DOI: 10.1016/j.radonc.2015.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 02/07/2015] [Accepted: 02/08/2015] [Indexed: 01/17/2023]
|
11
|
Loaiza-Bonilla A, Clayton E, Furth E, O'Hara M, Morrissette J. Dramatic response to dabrafenib and trametinib combination in a BRAF V600E-mutated cholangiocarcinoma: implementation of a molecular tumour board and next-generation sequencing for personalized medicine. Ecancermedicalscience 2014; 8:479. [PMID: 25435907 PMCID: PMC4239128 DOI: 10.3332/ecancer.2014.479] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Indexed: 12/12/2022] Open
Abstract
This is the case of a 47-year-old woman diagnosed with chemotherapy and radiation-refractory BRAF V600E mutant, poorly differentiated intrahepatic cholangiocarcinoma (ICC), with multiple metastatic lesions within the liver, lungs, pleura, and bone, stage IV. Discussion of her malignancy's next-generation sequencing genomic information at a multidisciplinary molecular tumour board took place. The patient was considered a suitable candidate for dual BRAF and MEK inhibition, with the intent to prolong her survival and optimize the quality of life. We report her excellent tolerance and exceptional response to dual therapy with dabrafenib and trametinib, including symptomatic and sustained near-complete radiological improvement. We also briefly review the current knowledge of the genomics of cholangiocarcinoma with a focus on BRAF mutations, and make a point of the importance of the establishment of a molecular tumour board for personalized genomic medicine approaches. To our knowledge, this is the first reported case of the use of personalized genomic information for the successful management of a patient with ICC, and it is also the first description of dual BRAF and MEK targeted therapy in this malignancy, leading to what is considered an exceptional response.
Collapse
Affiliation(s)
- Arturo Loaiza-Bonilla
- Abramson Cancer Center of the University of Pennsylvania, Perelman Center for Advanced Medicine, Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Erica Clayton
- Abramson Cancer Center of the University of Pennsylvania, Perelman Center for Advanced Medicine, Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Emma Furth
- Abramson Cancer Center of the University of Pennsylvania, Perelman Center for Advanced Medicine, Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Mark O'Hara
- Abramson Cancer Center of the University of Pennsylvania, Perelman Center for Advanced Medicine, Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Jennifer Morrissette
- Abramson Cancer Center of the University of Pennsylvania, Perelman Center for Advanced Medicine, Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
12
|
Gene Expression Profiling of Tumors From Heavily Pretreated Patients With Metastatic Cancer for the Selection of Therapy: A Pilot Study. Am J Clin Oncol 2014; 40:140-145. [PMID: 25144266 DOI: 10.1097/coc.0000000000000116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Recently, it has been shown that it is possible to identify tumor profiles of sensitivity for potentially useful drugs, both conventional and experimental, based on whole oligonucleotide microarray gene expression studies in heavily pretreated patients with metastatic solid tumors. METHODS Fresh-frozen tumor biopsies for molecular profiling (MP) were obtained from patients with advanced and refractory cancer. Total tumor and control tissue RNA was hybridized to a whole human genome oligonucleotide microarray. Differentially expressed genes interacting with potential therapeutic targets were identified. Results were complemented with DNA sequencing of selected driver genes and with immunohistochemistry and fluorescent "in situ" hybridization. The results were used to guide experimental treatment. RESULTS MP assays led to a potentially active available drug in 91.2% of the patients. The median number of available active drugs per tumor was 5 (range, 1 to 9). Nine treated patients were not evaluable for response. Partial response was observed in 18 patients (33%), stable disease in 22 patients (40%) (clinical benefit rate of 73%), and progression in 15 (27%). Overall median progression-free survival and overall survival were 8 and 13 months, respectively. CONCLUSION MP-guided therapy is feasible and seems to improve the clinical outcome of extensively pretreated patients but prospective and confirmatory trials are needed.
Collapse
|
13
|
Hegmans JPJJ, Aerts JGJV. Immunomodulation in cancer. Curr Opin Pharmacol 2014; 17:17-21. [DOI: 10.1016/j.coph.2014.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 06/11/2014] [Accepted: 06/14/2014] [Indexed: 12/12/2022]
|
14
|
Abstract
Cells within tumours have diverse genomes and epigenomes and interact differentially with their surrounding microenvironment generating intratumour heterogeneity, which has critical implications for treating cancer patients. Understanding the cellular and microenvironment composition and characteristics in individual tumours is critical to stratify the patient population that is likely to benefit from specific treatment regimens. Here, we will review the current understanding of intratumour heterogeneity at the genomic, epigenomic and microenvironmental levels. We will also discuss the clinical implications and the challenges posed by intratumour heterogeneity and evaluate noninvasive methods such as circulating biomarkers to characterize the cellular diversity of tumours. Comprehensive assessment of the molecular features of patients based on tumour specimen characterization (including intratumour spatial and temporal variations), ancillary noninvasive methods (such as circulating biomarkers and molecular imaging approaches) and the correct design of clinical trials are required to guide administration of targeted therapy and to control therapeutic resistance. Finding the means to accurately determine and effectively control tumour heterogeneity and translate these achievements into patient benefit are major goals in modern oncology.
Collapse
Affiliation(s)
- J Seoane
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | | |
Collapse
|
15
|
Abstract
Health systems and the clinical research landscape evolve continuously owing to increased risk aversion, scrutiny by funding bodies, and costs of clinical trials. In this context, however, current drug development procedures are far from optimal, as exemplified by the late-stage failure of several drugs. The identification of new drugs urgently requires approaches based on a solid understanding of cancer biology, and that will support the design of robust confirmatory trials. The complexity and the costs of drug development are now beyond the knowledge and operational capacity of single organisations, therefore, a drastic deviation from the traditional path of drug discovery and new forms of multidisciplinary partnerships are needed to succeed in this sector. The European Organisation for Research and Treatment of Cancer (EORTC) proposes the use of collaborative molecular screening platforms (CMSPs) as a new approach to tackle this issue. These CMSPs have the advantage of optimizing the expertise of several partners and combining efforts alongside with cost-sharing models for efficient patient selection. This article describes some of the challenges to advancing drug development and improving medical treatments and how these hurdles can be overcome.
Collapse
|
16
|
|