THE WEEK · JULY 29, 2018 21HEALTHA
54-year-old teacher
came to see me for a
second opinion with
metastatic breast
cancer in 2014. Her
cancer had already spread to her
brain, liver and lungs. Because of
the extensive lesions in her lungs,
she couldn’t breathe and was on
oxygen. Her pain was unbearable.
Her breast cancer was triple neg-
ative, which is an aggressive sub-
type of breast cancer (15 per cent).
This type of breast cancer doesn’t
express oestrogen receptor/pro-
gesterone receptor and Her-2 neu
protein. Because this type of breast
cancer is more common in patients
with BRCA mutation (germline
mutation), we tested her blood for
that gene. Her testing showed that
she carries BRCA 1 gene, which
is seen in about 5 per cent of all
breast cancers. Then we did next-
generation sequencing (somatic
mutation) of her tumour. Her tu-
mour had multiple mutations, in-
cluding BRCA mutation.
Based upon all the information,
we selected a treatment plan for
her. That regimen included a PARP
inhibitor (Olaparib), which targets
the germline BRCA mutation. She
was part of our clinical research
trials using a targeted therapy. She
is more than three years post com-
pletion of treatment and cancer
free. She is working full-time, play-
ing tennis and riding bike to raise
money for cancer research.
As per the World Health Orga-
nization and the American Cancer
Society, one in eight deaths world-
wide is due to cancer, and it is rap-
idly becoming a global pandemic.
There were 14.1 million new can-
cer cases and 8.2 million cancerdeaths in 2012. But the good news
is that major advances are happen-
ing in the fi eld of cancer research
and therapy. The three areas that
will change the future of medicine,
especially cancer treatment are:
personalised or genomic medicine,
immunotherapy and gene editing.Personalised and
genomic medicine
Cancer is a broad diagnosis of
many different unique diseases,
often named after its organ of
origin. Even within each diag-
nosis, for example, breast cancer
can be divided into three to fi ve
different subtypes. As you can see
from the patient’s story above, by
understanding the biology and
using germline mutations or next
generation sequencing, we can po-
tentially identify dominant path-
ways of cell proliferation. That
will give us potential targets and
novel treatment options. Most of
the premier cancer centres in the
US use next generation sequencing
to select patients for genomically
driven clinical trials. We have a
genomic tumour board, compris-
ing clinicians, genomic experts,
pathologists and clinical research
experts. We review each patient’s
story and next-generation se-
quencing reports and fi nalise the
treatment plan. National Cancer
Institute's MATCH trial is one of
the largest genomically driven tri-
als.
The challenge and opportunity
with this approach is that there
are many mutations for which we
don’t have the right drugs to use.
We need more clinical trials using
genomic data. This will change the
future of cancer treatment.