Genetics expertise helps make precision medicine a reality
Ben Gilmer chokes up when talking about walking his daughter down the aisle last May. He wasn’t sure he’d be alive to make that stroll after hearing in 2014 he had stage IV non-small cell lung cancer.
“My wife, Donna, and I were stunned, because I’ve never smoked and I’ve always been active,” says Ben, who turned 72 in November. “I owe my life to the experimental drug I’m taking.”
“Ben and I were adamant about wanting the very latest treatments, even if they were experimental,” Donna says. “Patients and caregivers need to feel empowered to be part of their care.”
Matching Ben to an experimental drug that specifically targets his cancer’s genetic abnormality took persistence. And for so-called precision medicine, that’s more the rule than the exception.
“Precision medicine holds a lot of promise, but it’s still in its infancy and there are many challenges to making it a reality for more patients,” says Funda Meric-Bernstam, M.D. Overcoming those challenges is the goal of the Precision Oncology Decision Support (PODS) team, which provides tools to help cancer doctors navigate the sea of cancer genetics and match the right drug to the right patient at the right time.
Ocean of abnormalities
Experts estimate humans have 19,000 genes. Scientists are learning as much as they can about genes and genetic abnormalities.
“With advances in genomic testing, we know there are a vast number of genetic abnormalities, but we’ve learned not all abnormalities are equal. Some cause problems. Others don’t appear to,” Meric-Bernstam explains.
It’s not uncommon for cancer patients to have several abnormalities.
“Patients can get genomic testing that shows a list of genetic abnormalities, but that’s only helpful if something can be done with that information,” Meric-Bernstam says.
Determining the right problem and the right drug
An oncologist with a list of a patient’s genetic alterations has a starting point.
“The first question is, ‘What is known about those particular abnormalities?’” says Vivek Subbiah, M.D., who’s testing the drug that’s helping Gilmer and others.
“We have to know if any of the abnormalities are known to be important to cancer. And if there’s more than one, do we know how to predict which would be best to target with treatment?”
If the answers to these questions are yes, the right problem has been identified. Then the questions move to treatments. Is there a drug that targets that abnormality? If so, can the patient get it? Many of these targeted therapies are being tested in clinical trials, and patients have to meet specific criteria to join the trial to get the drug.
Expanding the cancer care team
Using the latest scientific knowledge to answer these questions requires oncologists to expand the team of experts assembled to best help patients.
“MD Anderson pioneered multidisciplinary care – teaming oncologists with pathologists, surgeons, radiation oncologists and other specialists. Expanding the team further to include genetics expertise is a natural evolution,” says Amber Johnson, Ph.D., precision oncology scientist.
Subbiah says this type of expertise isn’t a luxury, but a necessity to offer the best to cancer patients.
The best for Ben turned out to be the drug vemurafenib.
Ben recalls that when he was adamant about not doing traditional chemotherapy, John Heymach, M.D., Ph.D., said he could try genetic testing.
“But he cautioned it was a long shot,” Ben says.
The long shot paid off. His cancer has an abnormality in a gene called BRAF.
Today, that’s a well-known cancer mutation. Had it not been, PODS could have provided information about the mutation.
“We continually search the scientific literature and other databases to provide oncologists with the latest evidence,” Johnson says.
The PODS team also works to provide information about drugs that target different abnormalities and trials testing new drugs.
“We’ve created informatics systems that search through information about targeted drugs and clinical trials here to provide oncologists with options that match the specifics of that patient,” Jia Zeng, Ph.D., says.
The match for Ben was Subbiah’s trial, which is testing vemurafenib for BRAF mutations in patients with different types of cancer.
“When I was diagnosed, the computer screen showing where I had cancer was covered in orange, yellow and white. It was so bad, they couldn’t operate, so I started taking the pills,” Ben says. “Two months later the screen was black. The cancer couldn’t be detected.”
Ben’s been on the drug for more than a year.
His wife says the drug is a miracle.
“I’m convinced he wouldn’t be alive if not for this treatment. He’s a little tired, but he’s still very active,” Donna Gilmer affirms. “We’re so grateful for Dr. Subbiah and his team.”
While Ben’s dramatic response is the goal for all patients, much work remains to make that a reality. Thanks to PODS, MD Anderson oncologists have a powerful new resource to benefit patients who can be helped by precision medicine.