Continued Progression in Cancer Diagnostics and Discussion

Editor’s Note: In this article the author continues an interview with Dr. Richard Schilsky, previously covered in “Cancer: A New Age in Treatment?

“As our population ages, cancer will increase in incidence and in prevalence,” says Dr. Richard Schilsky. As I continue my interview with Dr. Schilsky, however, he appears to be promoting a more positive outlook on cancer. Now there is a new view on cancer, as it is coming to be seen more as a chronic illness rather than a life-ending prognosis. However, it is important to understand that cancer is not one disease. Rather, Dr. Schilsky says that it is “thousands of diseases.” There are five types of breast cancer alone, along with four to five types of lung cancer. Therefore, each person’s cancer is unique, and we must look to map these unique genomes. There have been measures taken to understand and track each person’s cancer from its mutational and epigenetic stages to see what drives it.

For example, at Washington University in St. Louis, research has been conducted with the aim of being able to test an affected patient’s genome and make a conclusion as to the long term spread of the disease. The researcher’s main focus was eye cancer, ocular melanoma, in which they found that up to 97% of cancers that spread to different organs, called metastatic cancers, could be tested for. Researchers also found that this difference could be whittled down to 12 genes that, if tested, could determine the next step for the doctor in treating their patient.1 Ultimately, this will allow for specialized treatment that can often preempt the effects of cancer.

Dr. Schilsky looked to focus on the plethora of medical devices that are slowly changing the face of cancer and the very nature of its treatment. Medical devices are changing and adapting at the forefront of medicine. Recently, Dr. Schilsky notes, “In-vitro diagnostics have been really exploding in cancer studies.” In the realm of cancer, there have been multiple drastic changes especially focusing on early cancer detection. For example, Hologic Inc. recently received a patent from the FDA for the only 3-D mammogram unit. Normally, the 2-D units miss about 20% of tumor growths that can lead to malignant cancers.2 However, this system would take multiple screen shots and collate them to create an image that clearly defines any abnormal growths on the body. With such imaginative machines coming forth, the future of cancer treatment looks bright.

Clinical studies have become more prevalent as more and more consumer drugs come down the pipeline.  Cancer drugs appear to be on the forefront of the drug development process, which points to positive outcomes in the field for years to come. Dr. Schilsky focuses specifically on Phase I studies. In Phase I, study coordinators work with anywhere from 25-40 people. At the University of Chicago Pritzker School of Medicine, all phases of clinical studies are tested with the number of human test subjects involved increasing from Phase I to Phase IV. In Phase I, researchers test for a “tolerable dose for subsequent testing” of clinical drugs. This allows them to find out the toxicity profile of the drug before actually testing for any adverse effects, as well as the drug’s effectiveness. The results of these tests allow the amount prescribed for future testing to be adaptable. After the drug has gone through the testing “pipeline” it can be brought to the public.

One of the most interesting new drugs being tested is meant to restore the functionality of a protein called p-53 that has been called the “cancer suppressor.”3 The reason the protein is named this is due to the fact that it can often respond to cancerous growths and the changes in the cell cycle that cancer causes and attempt to destroy the cell from the inside. However, in more than half of all the cancer cells that are being tested at The Cancer Institute of New Jersey, researchers found mutated p-53 proteins.3 By testing their drug on these strains they found that certain cells could actually have the functionality of their p-53 restored without harming normal cells in the process. Dr. Darren Carpizo, a co-author of the study on this drug aptly states, “Anti-cancer drug development is moving in the direction of ‘personalized medicine’ in which the drugs are chosen based on the molecular pathways that are deranged in an individual patient’s tumor.”3 With more solutions arriving in the form of drugs that selectively target cancers and their mechanisms of proliferation, there appears to be hope that the effects of cancer can be mitigated in each individual’s personal case.

In addition to improvements in clinical treatment, doctors are also looking for a wider base of knowledge on the subject. Medical conferences have increased in prevalence over the years. However, their differentiation has come to define them. For example, ASCO (The American Society for Clinical Oncology) holds a conference tailored towards physicians while the AACR (American Association for Cancer Research) annual meeting tends to draw in translational cancer researchers. At the ASCO conference, it is not uncommon to see large drug companies such as Pfizer and Eli Lilly vie for funding and the prevalence of their respective cancer drugs. For example, in preparation for the ASCO conference approaching in early June, Pfizer has begun to heavily market its keystone drug axitinib, which is tailored to the treatment of renal cell carcinoma.4 Naturally, such high stakes lead to tensions for drug companies, which naturally causes greater movement to find drugs that have been proven to work. On the other hand, the AACR looks to publish comprehensive cancer journals such as Cancer Epidemiology, which can help to create a forum for research, and even provide grants for beginning cancer investigators to hone their craft.5 In addition to these general conferences, which can draw as many as 20,000-30,000 people, there are thematic meetings that are smaller and more collaborative, as specific research findings are integrated and doctors are able to share their opinions more often. Meetings have commonly become based on biomarkers as well. The sheer quantity of conferences has increased while doctors are becoming better able to hone in on what type of conference they would like to attend. Therefore, cancer doctors are able to adapt and share their ideas as their field itself adapts to the various positive changes that will come in the future.

References

  1. Science Codex. 2012. “Genetic Test Identifies Eye Cancer Tumors Likely to Spread.” Accessed May 14, 2012.
  2. Natoli, Cori. “Hologic’s 3-D Scans Improve Breast Cancer Imaging.” The News Journal. Accessed May 15, 2012.
  3. Yu, Xin et al. 2012. “Allele Specific p53 Mutant Reactivation.” Cancer Cell. Accessed 25 May 2012. doi: 10.1016/j.ccr.2012.03.042.
  4. Carroll, John. Fierce Biotech. 2012. “Cancer Drug Developers Angling for Center Stage at ASCO.” Accessed May 15, 2012.
  5. AACR. “About Us.” Accessed May 15, 2012.
  6. Image credit (Creative Commons): Weiss, Marianne. “CTBTO Science and Technology conference“. Wikimedia Commons. Accessed July 1, 2012.
  7. Image credit (Creative Commons): Moses, Melinda. “Joseph Martin Conference Center.” Wikimedia Commons. Accessed July 1, 2012.

Jawad Arshad is a rising second-year student at the University of Chicago majoring in economics and biological sciences. He has interests in both medicine and financial consulting and hopes to apply his passion for both of these topics in his articles. Follow The Triple Helix Online on Twitter and join us on Facebook.

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