Cutting-Edge Cancer Care in Two Cities
San Diego may not have January blizzards and Sioux Falls may not have ocean views, yet these two cities have one feature in common that’s of special interest to cancer patients and physicians.
Both are home to cutting-edge personalized medicine programs that provide genomic testing to cancer patients and then match them to the right drugs for their specific genomic mutations.
The University of California San Diego (UCSD) Moores Cancer Center has done genomic profiling on some 8,000 patients since Razelle Kurzrock, MD, started the program there five years ago.
“What we are seeing – and we are just beginning to publish it – is that if we do customized combinations of therapy or match patients with the right drugs we can see responses even in patients who have been deemed untreatable by conventional therapies,” Kurzrock said.
In the past, cancer has been diagnosed by looking at the surface of the cell under a microscope and determining whether it originated in the lung, breast or other location. “We are now able to probe deep into the cell and understand the precise alterations that lead to cancer cell progression. We also have drugs that can reverse those specific problems,” Kurzrock said.
The Avera Cancer Institute's genomics team share this philosophy with the program she’s led in San Diego. “In fact, for our clinical trial known as I-PREDICT – Profile-Related Evidence Determining Individualized Cancer Therapy – we chose one other site, and that was Avera,” Kurzrock said.
“We are two teams that are literally trying to transform cancer care,” Brian Leyland-Jones, MB BS, PhD said. Avera’s program has provided genomic testing to 650 patients, with positive results that mirror what’s happening in San Diego.
Mary Bowden, formerly of Sioux Falls and now from Arizona, is one of those patients. She was diagnosed with triple negative breast cancer, a particularly aggressive form of breast cancer. In researching cutting-edge treatment options, she and her husband, Doug, learned more about Avera’s Precision Oncology program.
She had targeted chemotherapy first, and by the time she had surgery, her cancer had shrunk down to the size of a grain of rice. “Now, I am basically cancer free,” Bowden said.
“What we did was to challenge the process. We were not going to settle for the current standard treatment,” Doug said. “We had already studied up and understood the benefits of genomic testing and then lo and behold we figure out that one of the top programs in the world happens to be right here in Sioux Falls.”
“It’s not a trend, it's the way of the future,” Mary said. Doug agreed, saying, “If someone we know has cancer, the first question we ask is, ‘Have you had genomic testing? If not, and the doctor you are seeing does not support this approach, find one that does. You won't regret it.’”
Clinical trials are now beginning that focus on an individual patient's precise genomic profile and not on the average response rate of all previous patients with no genomic profiling performed. These are termed N of 1. “We can sequence the genes that can go wrong in a particular patient and come up with a cocktail of targeted drugs and immunotherapy to hit what we call the patient’s N of 1 profile,” Leyland-Jones said.
Leyland-Jones and Kurzrock said they would like to see a future when every cancer patient has genomic profiling, and where all oncologists are precision oncologists.
“Besides treating patients, the most important thing we do every day is to try to inspire our colleagues and train the next generation of oncologists,” Leyland-Jones added.
Availability of drugs and getting the use of those drugs paid for by insurance remains an issue. That’s because genomic profiling might point to using a drug or multiple drugs that are not standard of care for a given type of cancer. “This is a new field. As the data comes out there will be stronger evidence for precision medicine,” Kurzrock said.
“I think we at UCSD are right at the cutting edge and Avera is right at the cutting edge. I honestly don’t know of another cancer center that’s further along in giving customized combinations of drugs to patients with cancer,” Kurzrock said.