FRONTLINE CANCER: Welcome to the biggest decade of discovery in medical history
When the director of the National Institutes of Health (NIH) and the director of the National Cancer Institute (NCI) speak with one voice, it’s time to listen. When they echo the words of the President of the United States, it’s time to act.
In his State of the Union Address, President Obama debuted his $215 million “Precision Medicine Initiative,” intended to accelerate progress toward a new era in medicine in which disease treatment and prevention is based upon the particulars of each patient, whether it’s minute differences in their DNA or variables in biological processes, such as how their immune system works.
The initiative would “bring us closer to curing diseases like cancer and diabetes,” declared the president. Precision medicine promises to deliver “the right treatments at the right time, every time, to the right person,” he said.
NIH director Francis Collins, who led the game-changing Human Genome Project, and NCI director Harold Varmus, also a former NIH head and a Nobel laureate for his cancer research, could not agree more. Writing in the New England Journal of Medicine, they took note of the president’s enthusiastic support for precision medicine, discussed its challenges and debated its ultimate goal: To give everyone the best chance at good health.
Such rhetoric might cause pause. The history of science is well marked by grand ambitions that have fallen short, and curing complex diseases is a decidedly difficult and daunting business. So it’s reasonable to be skeptical, to wonder about the feasibility of an idea like precision medicine. Can such a thing really be done?
These are early days. Much remains to be done, such as collecting and interpreting the genetic information of one million Americans and translating basic discoveries into clinical benefit. But in some cases — and in some places — the future has arrived.
For cancer research and treatment, specifically, precision medicine has become practiced medicine. The last decade or so have seen incredible, even radical, advances in the depth and breadth of our understanding of cancer.
At the UC San Diego Moores Cancer Center, for example, the Center for Personalized Cancer Therapy already performs advanced clinical-grade molecular diagnostics on any patient with advanced cancer where the physician feels such information may be relevant to the patient’s care. There is a weekly Molecular Tumor Board that brings together doctors of multiple specialties, basic scientists, geneticists, bioinformaticists and experts from the San Diego Supercomputer Center to discuss patients with difficult cancers and how best to formulate the singular treatment most suitable for each of them.
“If we examine tumors from patients with metastatic disease,” said Razelle Kurzrock, M.D., director of the Center for Personalized Cancer Therapy, “we find that no two patients have the same portfolio of molecular/biologic abnormalities. Patients have metastatic tumors that are ‘malignant snowflakes.’ Not only do they need drugs that target their tumor abnormalities with precision, each patient also needs therapies that are personalized for their particular tumor.”
Last year, UC San Diego and La Jolla-based Human Longevity, Inc. (HLI) began a collaborative effort to sequence the genome of every consenting Moores Cancer Center patient. HLI was co-founded by J. Craig Venter, Ph.D., a UCSD alumnus best known for his central role in sequencing the human genome. (Venter and Collins at the NIH are generally credited as being the primary drivers of that effort, with Collins directing a publicly funded program while Venter headed a company focused on the same effort.)
Recently, Venter was invited to the White House to hear President Obama further elaborate upon the Precision Medicine Initiative. He said the scene was evocative of his visit to the White House in 2000, when it was announced that the human genome had been successfully sequenced. It was inspiring. It felt like something big was happening. “Maybe bigger,” Venter said. “This was the president speaking. It was a larger stage. There were more players involved, including the FDA, and a bigger buy-in.”
Often in science, the more you learn, the less you seem to know. Answering one question provokes 100 or 1,000 more. Such ought to be the case with cancer, but Venter believes we have reached a particular moment of profound opportunity. This next decade “will be the biggest decade of discovery in medical history,” he said.
It remains true that the more we learn about cancer, the more we learn about what remains to be learned — the known unknowns, so to speak. But Venter argues persuasively that we have developed sufficient tools to do a job unimaginable just a few years ago, from high-throughput sequencing technology to managing massive amounts of Big Data that would boggle the mind.
“Advances in genomics and other ‘omics’ are going to sort out a lot of basic questions,” he said. “The costs and time of sequencing the human genome have dropped dramatically from $100 million and 9 months when I sequenced the first human genome to less than $1,000 and one day. We can do a lot of things faster and cheaper.”
The president’s initiative marks a beginning, especially in terms of treating and preventing cancer. At Moores Cancer Center, we’ve already started.