By Jessica Gorman
The Perfect Prescription
Can new research get a patient's cancer treatment just right?
By Jessica Gorman
In the spring of 2005, many people were somewhat puzzled when they heard that a new lung cancer drug hadn’t increased patients’ survival time. After all, the U.S. Food and Drug Administration (FDA) had already taken the unusual step two years earlier of approving the drug, Iressa (gefitinib), using an accelerated approval process.
Perhaps the people most perplexed by the trial’s negative results were a small group of lung cancer patients themselves. Alive after as many as two to three years on Iressa, their response to the drug has been described as nothing short of Lazarus-like: Their tumors had shrunk so remarkably that they had come back from near-death, despite living with a cancer from which 60 percent of patients die within a year and 75 percent within two years.
Iressa’s powerful effect for just a small number of people was a baffling puzzle at first, but the basic reason behind it is why many therapies work for subsets of patients with other types of cancer as well: Cancers that originate in the same organ and look the same on microscope slides can be different diseases genetically and respond uniquely to treatment.
“What we’re learning based on the latest advances in science is that one size doesn’t fit all,” says medical oncologist Funmi Olopade of the University of Chicago. “For any type of cancer that we look at there are genetic mechanisms that drive the behavior of a tumor. So increasingly, we’re going to have to individualize how we look at risk factors and how we look at tumors. And most importantly, I think, for oncology care, based on those observations, we’re going to pick the right type of treatment.”
The potential benefits of picking the right type of treatment—or personalizing medicine, as many people call it—are huge: better treatment, fewer side effects, and less wasted time and money on therapies that don’t work. The challenges, however, are also great: changes in the drug development and clinical trials processes, logistical hurdles to the collection and testing of patients’ tissues, and potentially large costs to patients and drug companies, just to name a few. And cost should not be taken lightly, many patient advocates and others point out: If these personalized treatments end up costing patients more than they (or their insurers) can pay, whom will these exciting new medical developments help?
PERSONALIZED MEDICINE: A PERSONAL CONCEPT
The idea of “personalized medicine” is one that has been evolving. It has had—and still has—such a variety of meanings that patients, oncologists and cancer researchers frequently have somewhat different definitions for it. In addition, many doctors and researchers use alternative expressions, such as “patient-directed therapy,” to refer to the same concept another person might call personalized medicine.
On some level, all medicine may be considered personalized, says medical oncologist Ronald Levy of Stanford University School of Medicine in Stanford, Calif. “I feel this whenever I go to clinic and take care of patients,” he says. “We never treat everyone the same, so the whole job of being a doctor is to deliver personalized medicine.”