Cancer Treatment: Are Personalized Molecular Profiles in Our Future?

Uploaded by PBSNewsHour on 13.01.2012

bjbjLULU JUDY WOODRUFF: Now: the second in our two-part series on changes in treating
cancer. Last night, NewsHour health correspondent Betty Ann Bowser looked at the effects on
childhood cancers. Tonight, she examines how researchers are tailoring individual treatments
to cure or manage the disease in adults by attacking the genetic underpinnings. BETTY
ANN BOWSER: Sydney is a bone cancer patient, but even with just three legs, she is still
no ordinary dog. The 11-year-old yellow Labrador retriever is part of a research project under
way at the University of California, Davis. Like thousands of people who also have incurable
cancer, Sydney is treatable. And what researchers learn from her and the other dogs in the program
will be used to prolong the lives of humans. Dr. Ralph deVere White is director of the
Davis Cancer Center in Sacramento. DR. RALPH DEVERE WHITE, Davis Cancer Center: They live
in our environment. They have multiple genetic abnormalities in their tumors. We can biopsy
that tumor. We can image that tumor. We can monitor how the tumor responds. We can do
molecular analyses of the tumor before the treatment, during treatment and after treatment.
If they're cured, we will then look at all of that. If they are not cured, because they
die at a younger age in terms of lifespan, we get more information, and hope that we
will have a bigger hit rate. BETTY ANN BOWSER: It has been 40 years since the federal government
promised to find a cure for cancer. But after hundreds of billions of dollars have been
spent on research, it still claims more lives every year than anything except heart disease.
Modern medicine has learned a lot in those years about what cancer is, that it's many
hundreds of diseases, not just one, that it starts when the DNA in human genes is damaged,
and that some cancers can be cured when treatments target those altered genes and stop cells
from growing out of control. But pancreatic, colon, liver, prostate, and lung cancer still
kill more than half-a-million Americans every year. And some forms remain stubbornly resistant
to cures. Dr. David Gandara is an oncologist at U.C. Davis. DR. DAVID GANDARA, U.C. Davis
Cancer Center: These cancers have been described as smart cancers. The molecular biology is
complex. So, for contrast, for example, some leukemias, for instance, pediatric leukemias
in children are simple cancers. There might be just a few genes which are altered. And,
therefore, treatment is a lot more likely to have an impact. But if you have a cancer
like pancreatic cancer or lung cancer, where literally there might be hundreds of genes
that might be altered in even one patient's cancer, then sorting that out and figuring
out why Mrs. Jones has to be treated differently than from Mr. Smith, it is a major task. And
now we're finding out, just like everything else, it s not as simple as we thought. BETTY
ANN BOWSER: But knowing more about the molecular nature of cancer has ushered in a new age
where the disease is no longer an immediate death sentence. Today, many cancers that once
were fatal are now successfully treated. And even those that remain resistant to treatment,
like lung cancer, while not always curable, can be managed for long periods of time. Gandara
manages people with incurable lung cancer in clinical trials. It s still the deadliest
of all cancers, but he's able to prolong life by targeting each patient's individual molecular
fingerprint. DR. DAVID GANDARA: One person's fingerprint is different from another's. And
if a doctor then can use that information to personalize treatment for that patient,
so that they get the best chance of getting a remission or a cure from their cancer, then
that's really an advance. And so it may be that, at the end of the day, we cure cancer
one patient at a time. BETTY ANN BOWSER: When 59-year old lung Jane Coyne came to Gandara
19 months ago, the lung cancer had spread to her brain and bones. Were you scared? JANE
COYNE, lung cancer survivor: Petrified, absolutely petrified. I thought that, with a stage four
lung cancer, that I was a goner. I had seen statistics online that I think my chance to
make it the first year was 15 percent. The first thing he said to me was, "I can't cure
you, but I can manage you." BETTY ANN BOWSER: That meant using genetically engineered mice
developed at the Jackson Laboratory in Sacramento. Gandara surgically removed small pieces of
Coyne's tumor and had them grafted into the animals. DR. DAVID GANDARA: That mouse is
designed to allow that patient's cancer to grow. What this means is, that this is not
a mouse cancer. It's a patient cancer. And not only is it a patient cancer. It's one
patient's cancer. BETTY ANN BOWSER: As Coyne's tumor tissue grew in the mice, Gandara and
his colleagues found out more. DR. DAVID GANDARA: We found from that analysis that she had a
specific mutation in her cancer which is more common in people who have lung cancer that
haven't smoked. It's called an EGFR mutation. And there is a drug for that. And we put her
on that drug, and she has gone into a marvelous remission. BETTY ANN BOWSER: Coyne is thrilled.
JANE COYNE: Absolutely miraculous. I mean, if there is any time to have the unfortunate
experience of having lung cancer, I'm in the right place at the right time to be able to
have a quality of life and to extend it. BETTY ANN BOWSER: But the drug, Tarceva, is not
a cure. JANE COYNE: It's a chemotherapy drug. At some point, it's going to run out on me.
And at this point in time, I don't think there is a next step. So instead of testing things
on me, they can test the mice to see if any new drug therapies will be of help. DR. DAVID
GANDARA: What we are hoping to do in the meantime, of course, is to take her cancer that is growing
in the mice at JAX and be able to study it molecularly, and also treat it in different
ways, so that when and if she needs it, we will have the next step in her treatment.
BETTY ANN BOWSER: Coyne and her husband, Ed, know that, at some point, Gandara may run
out of options, so she's living one day at a time. JANE COYNE: I feel well. I was able
to have a very good quality of life on the Tarceva. And I recently went to China for
two weeks, was able to travel. I'm back at the gym, playing with my grandchildren, doing
everything that I want to do. BETTY ANN BOWSER: And what about the future? JANE COYNE: You
know, I don't ask. I don't want to have that date out there. I don't want him to tell me,
oh, well the Tarceva might work for five years or seven years. I really don't want to have
that number in my brain. I go day to day, month to month. I think the thought of dying
is always in my thoughts daily. And you think about that, that things are short. Better
take care of what you need to take care of immediately. Don't delay. Take advantage of
every day that you have. BETTY ANN BOWSER: Coyne is one of the 20 percent of cancer patients
with incurable disease who are in a clinical trial like Gandara's. Most Americans don't
have access to this kind of sophisticated treatment, but Gandara sees a day coming when
targeted treatment will be available on a widespread basis. DR. DAVID GANDARA: What
we would like to be able to do in the future is -- it's a little bit like "Star Trek,"
where a patient goes into a pharmacy, and they say here is my molecular profile of my
cancer, and the pharmacist gives them a pill that's designed specifically for their cancer.
BETTY ANN BOWSER: Even with all the progress against incurable cancers, advocates are still
worried about the future, because federal funding for important research has been drying
up. But for people like Jane Coyne, who 40 years ago would have had no future, they're
grateful for what they ve got. hrA> hrA> hrA> hrA> gdrA> hrA> hrA> hrA> hrA> gdrA> hrA>
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