Tumor profiling can inform cancer treatment.
When Teresa McKeown was diagnosed with breast cancer in 2006, her disease was easily treated with standard therapies. But 11 years later, the cancer returned. This time, it morphed into what’s called triple-negative disease, an aggressive and difficult-to-treat form.
“I had one therapy after another,” she said, “and failed them all.”
Within weeks of the cancer’s detection, a tumor had grown in her small intestine, making it difficult to eat, and her peritoneal cavity, the space surrounding the organs in the abdomen, began to fill with fluid — the latter a sign she had just months, perhaps only weeks, to live. “I began writing goodbye letters to my children,” said the 57-year-old McKeown of Valley Center, Calif.
But then her luck changed. Through a clinical trial at Moores Cancer Center at UC San Diego Health, a test designed to reveal the genetic abnormalities locked inside tumors found a large number of them in McKeown’s cancer. The results raised the possibility that Opdivo, a drug that triggers the immune system to attack cancer and which was approved to treat melanoma, might work against the metastatic breast cancer cells ravaging McKeown’s body.
McKeown started on the drug in early 2017. After two infusions, her tumor markers, substances in the blood that reflect the amount of underlying disease, dropped dramatically. Within eight weeks, imaging scans showed no sign of cancer anywhere in McKeown’s body. Today, she remains cancer-free.
McKeown and other patients like her are rare but powerful examples of why sequencing the genome of a tumor to uncover the mutant genetics housed in its DNA — a practice known as comprehensive tumor profiling — is fast becoming a cornerstone of cancer treatment. The approach enables doctors to match individuals with cancer with drugs that target specific genetic mutations or other abnormalities in their tumor, often leading to unexpected recommendations, such as using a melanoma therapy for breast cancer.
But whether such stunning outcomes should be the exception rather than the rule has become a contested issue among oncologists. As these tests become more routine — helped largely by Medicare, which now covers them — patients and cancer physicians alike are asking whether comprehensive tumor profiling heralds a new era for cancer care or simply a higher price tag.
|Read on: Conquering cancer by attacking the disease’s genetic abnormalities|