Custom Search

MGH to use genetics to personalize cancer care

Cancer doctors at Massachusetts General Hospital plan within a year to read the genetic fingerprints of nearly all new patients' tumors, a novel strategy designed to customize treatment.The hope is to spare patients from the traditional hit-or-miss approach to cancer care, when expensive drugs with harmful side effects are often given without knowing whether they will work.

Doctors will hunt for 110 abnormalities, carried on 13 major cancer genes, that can predict whether drugs already on the shelf or in development might thwart a patient's tumor. They will use robots - and lab machines nicknamed John, Paul, George, and Ringo - that are capable of swiftly identifying genetic quirks in 5,000 to 6,000 patients a year, replacing labor-intensive techniques that had been used only selectively for a handful of cancers.

Mass. General's decision to make gene testing standard in cancer treatment - it's believed to be the first hospital in the nation to do so - represents a major step in delivering personalized medicine to the masses. But doctors acknowledge that it is unclear whether screening patients for an expanded library of tumor defects will actually save money on drugs, or whether it will translate into longer lives.

"Right now, as an oncologist, much of what we do is really barely educated guesswork in terms of what therapy is going to be the best for a particular patient," said Dr. Leif Ellisen, a Mass. General breast cancer specialist. "We needed a new way to think about cancer diagnosis and cancer therapy."

Routine tumor screening, which began with lung cancer patients this week, opens a window onto the frontier of cancer medicine, where doctors focus more on the genetic profile of a tumor and less on whether it's in the lung, breast, or prostate. The genes that reside inside the malignancy may prove vastly more important than its address.

The testing could be especially helpful to patients with rare tumors, cancers that stoke little interest among researchers or drug companies. That is because they may share genetic signatures with more common tumors already being successfully treated.

"What we've been trying to do is set the stage for this kind of personalized medicine," said Anna Barker, deputy director of the National Cancer Institute. "We'll be able to say, 'That drug will work well for you, that drug will not work well for you.' "

Still, cancer specialists from across the country - including at Mass. General - caution against vesting too much hope in any single approach to defeating a disease notorious for resisting medical advances.

Sometimes, they said, a tumor can harbor so many genetic abnormalities that no single test and no single drug proves sufficient.

"I'm one of the most enthusiastic people for molecular personalized medicine that you will find," said Dr. George Demetri, director of the Ludwig Center for Cancer Research at Dana-Farber Cancer Institute. "But the cancer field has sometimes been plagued by people saying, 'We're going to cure cancer next month.' "Continued...