Heard at ACCC’s Oncology State Society Presidents’ Retreat

The bedlam of the cancer genome, in short, is deceptive. If one listens closely, there are organizational principles. The language of cancer is grammatical, methodical, and even…quite beautiful. Siddhartha Mukherjee, “Emperor of All Maladies: Biography of Cancer”

by Don Jewler, Director of Communications, ACCC

We are about to experience a tsunami in cancer genomics, according to Randy Scott, PhD, executive chairman of Genomic Health and presenter at the Association of Community Cancer Centers’ recent oncology state society Presidents’ Retreat, held in Alexandria, Va. Why? Because genomics and computing are converging in the technology wave that will have dramatic and historic consequences.

Scott argued that the era of genomics has had to wait until the information age was well established, until we had powerful enough computers to store and analyze all the data generated from a complete map of gene mutations in tumor types. Soon we will have enough computing power to understand the “bedlam of the cancer genome” and the “language of cancer,” as oncologist and author Mukherjee so elegantly wrote.

Scott uses the word soon because we have not yet linked data from multiple genomes. “My genome in isolation won’t tell me much, but if I can link mine to millions of others to compare genetic information with clinical outcomes, then we begin to see a genetic revolution begin to occur. This will start to happen over the next few years, and we’ll see an amazing transformation,” said Scott. (The cost of DNA sequencing drops in half about every 9 or 10 months, said Scott. Before long, he believes the cost will be in the hundreds of dollars, and eventually free.)

Researchers are already finding of regions of the genome that do not actually code for protein but are highly selectively expressed only in certain biological systems and seem to correlate with clinical outcomes. Cheaper and better assays will help us find more and more biomarkers that correlate with disease. We can begin to fit the drug to the patient rather than the patient to the drug. For the first time in history, said Scott, we have tools in place to understand the underlying molecular biology of the disease in a level never known before.

Mutations litter the chromosomes, writes Mukherjee. The challenge, he says, is to coalesce patterns out of the mess.

Scott and his researchers are looking at 1,000 genomic transcriptions of breast, colon, prostate patients to identify all genes expressed, turned on or of, in those patients. The goal: to “coalesce patterns” and, thereby, understand what the gene mutations do. Once the crucial driver mutations in any given cancer have been identified, the hunt for targeted therapies against these genes can begin.

Information technology and the genomic revolution are coming together to create the kinds of disruptive technology that will improve healthcare, according to Scott. Will that convergence move us away from trial and error biology to a brave new world where targeted therapies (and prevention) become the new magic bullets against cancer?

Once, writes Siddhartha Mukherjee, the oncology community had “impossibly lofty goals and near-hypnotic conviction that cancer could be cured within the decade.”  Let’s hope that Scott’s optimism and great wave of “disruptive technology” lead us to the fruition of that goal.

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Need a refresher on genetics? Check out the “Role of Genetics in the Treatment of Cancer” in the January/February 2011 Oncology Issues. Valerie Relias, PharmD, and Gregory T. Brennan provide an excellent review of basic concepts.

What was the first cancer ever associated with a specific genetic abnormality? Find out.