Dr. Sameek Roychowdhury
What once was a common theme within science fiction writing, technological advancements in personalized medicine allow doctors the ability to deconstruct a patient at the genetic level to formulate a patient-specific therapy.
Precision medicine allows oncologists to more precisely diagnose why a particular cancer grows, according to Dr. Sameek Roychowdhury, a physician scientist with The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
“We’re really trying to refine what is going on with that person’s cancer that makes it unique and defines why their cancer is growing and why it’s spreading,” Roychowdhury says.
Roychowdhury indicates that if he were to evaluate 100 patients diagnosed with lung cancer, each one might be different based on their genetics and cancer.
“You might find 25 percent of them have an abnormality and another 1 percent of those patients … might have something very different,” Roychowdhury says. “What that means is that everyone’s cancer is quite unique and rare … and you try to match patients with the right therapy so, from beginning to end, it’s understanding the disease more precisely.”
In doing so, it can help develop diagnostic tests that can identify patients based on their biology and offer a specialized therapy, Roychowdhury says.
“It turns out that if you can match patients with therapy based on their biology, you’re more likely to do well and, in cancer for patients who have aged, you’re more likely to improve your survival, more likely to have response to the disease tweaking or improving, and avoiding therapies that may be less effective,” he says.
Precision medicine started in the research lab around 2008, while doctors at OSU and elsewhere started using basic research technologies three years later for gene sequencing for patients through pilot studies.
“More recently, in the past five years since 2013 and onward, the technologies are growing and growing in youth and many are not standard and routine, but many are being used in clinical trials at the James and other cancer centers. That sort of began the two-part movement for precision medicine, which is understanding the biology and making a diagnostic test,” he says. “The sequencing technologies can help us do both of those.”
The traditional way of identifying a person’s cancer through traditional methods has been determining where it came from with the help of a microscope by looking at cells.
“This is the cutting edge of development of clinical trials and oncology and I would say only a fraction of clinical trials are doing this and it’s still growing.” - Dr. Sameek Roychowdhury
However, technology known as next-generation sequencing is cheaper and faster and allows doctors to look at genetics.
“We’re now able to use technology to study the genes of our patients on a more routine basis … and we’re now using DNA and RNA sequencing, the building blocks of the genetic code, and we’re characterizing one person’s cancer at a time,” he says.
That involves identifying genetic changes in a person’s DNA, allowing doctors to determine what changes are driving a person’s cancer versus another person’s cancer.
“That discovery (and) research turns into diagnostic tests … and diagnostic tests and results can be used by an oncologist to see what type of therapy might be matched,” says Roychowdhury.
Patients are now being treated not solely based upon the type of cancer they have, but how it interacts with their genetics as well.
“This is the cutting edge of development of clinical trials and oncology and I would say only a fraction of clinical trials are doing this and it’s still growing,” Roychowdhury says. “Ten years ago, there were no trials with this, but today, 5 to 10 percent of the trials being developed follow this paradigm of genomic-based medicine.”
Roychowdhury, who has been at OSU since 2012, says that studies of precision medicine have also shown that if a doctor is treating a patient in which a marker has been identified, a medical professional is more likely to improve their outcome and survival and response rate.
“They’re more likely to benefit and live longer than if you were to choose another therapy without a marker,” he says. “I think the benefit is there, but the challenge is there’s a shortage of therapy and we need more therapy developed.”
Still, he says that more discovery and research also need to take place, noting that the biology and genetics of all cancers hasn’t been determined yet. Over the next 10 years, he hopes doctors will learn more about the biology of cancers while more drugs are approved.
“These technologies are allowing us to do all of those things … and so, there are some areas where we know quite a bit, but there’s much we don’t know,” Roychowdhury says.
Matthew Kent is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
