LRF Brooklyn, NY report - Part 1

[Guest guest]

Having just returned from the Lymphoma Research Foundation

Conference in Brooklyn, I came away with mixed feelings of

disappointment and hope at the real progress being made in

targeted therapy development.

The focus on the goal imperative for individualized therapy

was never given titled recognition of the many lectures

presented but was more obliquely addressed through the topic

of targeted drug therapy development. During one the Q & A

sessions, toward the end of the Conference, I asked the

panel the following question: " What is needed for

implementation of the goal of individualized therapy?

Recognizing that knowledge is far from being complete, could

you address the state of high resolution scanning and type

of scanning or DNA sequencing technology and to what level

of precision is needed to provide the basics for recognizing

appropriate treatments that are more apt to have maximum

effect on the cancer with minimal collateral damage to the

patient? " I wish I could report a good response to my

question but the issue was only addressed through the

narrower focus of the progress made in targeted therapy

development. One could easily mistake the answers as coming

from politicians rather than scientists.

I recall Dwyer reporting on Canadian research that

would indicate a likely patient response to Fludarabine. The

last post I made about Prof. S. Nijman's work in uncovering

resistance mechanisms to PI3K inhibitors is another brick in

the building of a comprehensive approach to individualized

therapy. Much more needs to be in place such as the

mechanism to pay for such testing of patients and funding

for parallel research to Prof. Nijman's work. Is the

insurance industry to be convinced that patient testing will

lead to better therapy outcomes and in turn more profit from

premiums? What is Govt.'s roll in pushing forward

individualized treatment mechanisms. How can we as patients

advocate for accelerated progress with individualized

treatment?

Upon returning home I found a better source of hope in

another Cancernetwork article: " EmCC Speakers Look Forward

to Widespread Personalized Patient Care " Reporter

Azvolinsky writes about the The European Multidisciplinary

Cancer Congress (EMCC) tackling the issues: " ..... Dr.

Baselga pointed out

...Snip... In this " classic therapy " era, only an empirical

approach to clinical trial design was possible, where

patient populations were unselected and large-scale trials

were necessary in order to see any treatment benefit. These

types of trials led to a high failure rate and minimal

benefits. “The system can no longer tolerate an incremental

benefit,”

.....Snip.... “We have to embark on a comprehensive genetic

characterization of tumors: chrosomomsal alterations,

epigenetics, mutations, and proteomics.”

.....Snip.... " 1) smaller smarter clinical trials without

the need for 1000+ , expensive trials, 2) the importance of

combination treatments 3) applying novel targeted agents

earlier in the course of disease, and 4) the study of

resistance to therapies. " Later in the article this key

paragraph appears by Prof. G Mills (MDA):

" The issue of the accrual of large amounts of sequencing

information is such that database storage costs outweigh the

costs of generating sequencing data, and said that this is

something that needs to be addressed. “The $1000 genome is

now the $100,000 analysis cost,” he said. Lastly, he pointed

to the expanded number of parties that are involved in

treatment development and implementation. He stated that

the ethics of telling patients about germ-line mutations

that are discovered during genomic sequencing needs to be

discussed thoroughly, and mentioned the need for

participation by the U.S. Food and Drug Administration in

the education of patients and physicians and the issue of

reimbursement for testing and sequencing. "

This was the kind of discussion I had hoped to provoke by my

question to the panel. One discussion by the panel was still

mired in the paradigm of " classic therapy " lamenting the

need for a large scale trial to pit one " sledgehammer

therapy against another sledgehammer therapy "

To read the entire article go to:

http://www.cancernetwork.com/display/article/10165/1958786

continued in part 2

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