By William Fitzgerald
Gordon Mills, M.D., Ph.D., recalls a proposal he wrote 18 years ago detailing the concept of personalized cancer therapy and its potential impact. Today, that idea is no longer a proposal, but a reality, and it's about to get a boost.
Under a new and innovative institutional protocol called Clearing House, which started in March 2012, scientists are delving deeper into the biology of patients' tumors, with hopes of identifying specific genetic markers and prescribing therapies to attack those markers directly.
Funda Meric-Bernstam, M.D., professor in MD Anderson's Department of Surgical Oncology, and Mills, professor and chair of the institution's Department of Systems Biology, are leading the effort that will test up to 200 genes known to influence cancer in patients with aggressive or recurring disease.
"In the first year, we'll have sequenced the genes of far more than 1,000 MD Anderson patients and are targeting to have more than 3,000 by the second year," Meric-Bernstam says. "This will accelerate our discovery approaches, and we can develop new clinical trials, in which we already have patients pre-identified to enroll."
While the research began with solid tumors, the Clearing House protocol has expanded to all diseases that have ongoing genomically selected trials, Meric-Bernstam says.
Mills is co-director of MD Anderson's Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy and Meric-Bernstam is medical director of the institute.
A transformation in cancer care
This undertaking is made possible through a revolution taking place in oncology. The costs to conduct these complicated tests have plummeted, and emerging technologies are making them easier and faster. To this end, researchers have developed another program, Unusual Responders, geared toward understanding more specific patient populations.
"For generations, some patients have shown exciting and almost unbelievable responses to therapy," Mills says. "It became absolutely clear that patients were trying to teach us something important, if we only paid attention and had the tools to learn from their responses."
For example, when an MD Anderson patient displays an exceptional response, Mills and his team will work to identify the possible genetic rationale. Then, they'll employ that knowledge to determine if the same drug will elicit a response in patients with similar circumstances.
Collectively, the two programs represent an integrated approach that begins on a level only visible through high-powered microscopes, but with an eventual impact that no loved one, friend or companion can deny.
Two exceptional responders
Erin Bond and Rachel Midgett have had unusually good responses to new treatments.
A study drug has controlled stage 4 melanoma for Bond (pictured at right).
Clinical trials and a rare surgical approach have kept Midgett's metastatic breast cancer at bay.
Read about this topic and much more in MD Anderson's 2011-2012 Annual Report.