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Cancer Treatment: Are Personalized Molecular Profiles in Our Future?

January 13, 2012 at 12:00 AM EDT
In the 40 years since the federal government promised to find a cure for cancer, hundreds of billions of dollars have been spent and much has been learned. Still, the diseases continue to claim more lives each year. Health correspondent Betty Ann Bowser reports on the past, present and future of cancer treatment.

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.

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.Dr. David Gandara, University of California, Davis

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.