Genetic Testing and Cancer – An Introduction to Personalized Medicine

[music] Genetic testing has really changed our approach
to cancer. Personalized cancer medicine means the right
patient with the right drug at the right time. And that’s really an interface of how can
we develop a roadmap for patients based on host characteristics — so patient characteristics,
tumor characteristics, so perhaps the genetic make-up or the proteins that are being expressed,
and then the appropriate medicine that will take both of those factors into case. We’ve made significant progress over the
past decade of really cataloging some of the genetic changes that we see when cancer occurs. So there are particular mutations that may
make someone more susceptible to developing cancer, there are other mutations that when
detected in the tumor, cause a dysfunction of a particular protein for which we’ve
developed drugs for. Personalizing therapy is looking for these
markers in tumors, so understanding: Is there a protein that is over expressed? Is something malfunctioning that may make
chemotherapy or targeted therapy more effective? And then really finding the right dose for
the patient, finding the appropriate setting to give those agents in. Often patients undergo genetic testing if
they have a family history of cancer. And so this kind of genetic testing is looking
to see if there is a germline mutation. So that’s a mutation that you inherently
have, and that may predispose you to a particular cancer. And that’s relevant for people who have
families in which cancer has been prevalent. The reason we want to know is to understand
if we can screen or do preventative measures to decrease the likelihood of developing cancer. The other big area in which cancer genetic
testing has taken hold and really shaped how we approach treatments is looking for particular
mutations that drive cancer. Now we know that, that mutations are ubiquitous
in cancer. That’s really how cancer forms, but what
we’re looking for are a particular signature of mutations or particular driving mutation
that may cause the cancer. Some cancers are more commonly marked by particular
mutations than others. So in lung cancer, we know that particular
mutations in EGFR or ALK which are present only in the tumor cells can cause the cancer
to grow and often the most appropriate initial therapy for those patients is an oral small
molecule inhibitor of those proteins. So there are multiple ways that we can use
testing in some cancers. It’s important to understand if there is
a prevalence of mutations and in some cancers, it is standard of care to get mutational testing. In other cancers, we don’t understand as
much about the genetics or the prevalence of these particular mutations, the mutations
that we can target is quite low, and that genetic testing may be done as part of a larger
clinical trial or as a research effort. The other piece of testing that changes therapy
for patients is a detection of particular proteins on their cancer. We want to understand how we can find out
which genes are the most important to target and which ones may be driving the cancer. Another effort that we’re all making is
to understand if we can find in the serum or in the blood particular proteins that are
expressed or fragments of DNA that also may correlate with the treatment outcome. So it may be that when someone has cancer,
we’re able to detect particular proteins when the cancer has been effectively treated,
either with surgery or immunotherapy or chemotherapy that that fraction of proteins goes down and
we can monitor them over time. Right now when we look to see if patients
have disease recurrence we do it with a CT scan or a PET scan or a MRI. And although those tests are wonderful, generally
if we can see something it’s more — it’s hundreds of thousands of cells. We’re now thinking about looking at cancer
as really as a needle in a haystack using tests, not only from the blood, but from the
urine, from the serum — to really treat cancer earlier, to detect cancer earlier,
and we believe strongly that that will lead to better outcomes. So when a patient first meets a cancer care
team, I think it’s important to have shared decision making. That means that the patient and the physician
need to understand exactly what stage of cancer it is. To understand if there are particular genetic
determinants of prognosis that may impact our first initial therapy or the likelihood
of response, but then to take this information and really center it around what is important
to you. The world of personalized cancer therapy is
evolving rapidly. You can find out more about this field on
Cancer.Net. [music]

1 comment

  1. THERE ARE NO GENES FOR CANCER THEY DON'T EXIST AND NEVER WILL. GOD DID NOT MAKE MAN IN HIS IMAGE AND THEN GIVE HIM 10 COMMANDMENTS TO FOLLOW, AND THEN PUT GENES US TO HARM US. TOTAL BULLSHIT AND THE SCAM THE DEVIL SATAN HAS BRAINWASHED PEOPLE WITH WHO IS RUNNING THE CANCER FIELD TODAY. WHERE YESTERDAY THE DEVIL SATAN WAS RUNNING THE DEATH CAMPS. WHAT IS GENETIC IS YOUR EATING HABITS. WE AS A FAMILY EAT THE SAME FOOD FOR BREAKFEST, LUNCH AND DINNER. SO WE TAKE THOSE BAD EATING HABITS WITH US THROUGHOUT OUR LIFETIME. IF YOU EAT BACON EVERYDAY YOU WILL EVENTUALLY GET HEART DISEASES LIKE YOUR FATHER AND MOTHER DID WHO ALSO ATE BACON EVERYDAY. THIS MEDICAL FIELD IS ALL BULLSHIT.

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