The recent announcement by a California company offering DNA blood tests (also known as “liquid biopsies”) for the early detection of cancer takes us to a place most of us expected we would get to, but much earlier than we are prepared for. Simply stated, our technology and rush to get new tests to market-even before we have a basic understanding of how to use those tests to improve the health of consumers–has outstripped our scientific understanding, and we ignore the implications at our own peril. [more]
First, some history:
The concept of having a blood test to diagnose cancer early is not new. In fact, I recall an international meeting about a decade ago where a lecturer predicted the diagnosis of cancer through a simple finger stick that would be sent to a lab for analysis.
Fast forward to June of 2009 when I was a guest on the Today Show and was asked to offer a closing thought telling viewers something they didn’t know about cancer. My comment was to the effect that one day in the not too distant future we would be able to find cancer cells circulating in the blood in people who didn’t … Continue reading →
(The following blog was originally posted on MedpageToday on August 3, 2015. It is reprinted here with permission.)
Genomics and its impact on clinical medicine appear to be the topics du jour. The science is rapidly advancing, but our ability to understand and apply that science may not be keeping pace. The question is whether expectations will meet the promise, and are we wise enough to navigate the maelstrom and bring true benefit to our patients and consumers in general?
Three recent research reports highlight how fast some of this discovery is moving. Two reports focused on the use of cell-free DNA fragments extracted from the blood and saliva to identify cancer related markers in patients with pancreatic and head and neck cancer. The other reported discordance in DNA from mothers and their fetuses discovered when prenatal blood tests were done, again using cell-free DNA. In short, the researchers reported on situations where a prenatal screen showed abnormal DNA, the fetus was tested and showed normal DNA which then led to the discovery of cancer in the mother.
To be certain, there are many similar research reports. But they all point in the direction that we are soon … Continue reading →
When it comes to personalized/precision medicine we should never forget it’s all about the people, particularly the cancer survivors whose very lives depend on us getting it done quickly and getting it right.
That was the message from a discussion I had the privilege to moderate on Monday evening with cancer survivors and representatives of advocacy organizations, professional associations, government agencies, and industry at a session held in conjunction with the annual meeting of the American Society of Clinical Oncology (ASCO), now wrapping up in Chicago.
There has been an incredible amount of big science presented at this meeting that relates very directly to the care we provide cancer patients. Some of that science has immediate application to cancer care. On several occasions, acknowledged experts opined in front of thousands of physicians, other scientists, and health professionals that new treatments-particularly immunotherapy-were new standards of care in the management of patients with certain cancers.
Running in parallel to the development of new approaches to the treatment of cancer is the science that is helping to define and personalize which patients would benefit most from which treatments. As an example, for the new immunotherapy drugs there are biomarkers that may eventually … Continue reading →
Question: What do all these cancers have in common: Melanoma, lung, kidney, bladder, ovarian, head and neck, Hodgkin lymphoma, stomach, breast (and others)?
Answer: They have all shown evidence of meaningful, durable responses when treated with one or more of the new immunotherapy drugs. And that is truly amazing-not to mention very unexpected, even by the experts who know this stuff.
The journey to this point has been fascinating. [more]
I personally had some interests in immunotherapy research back in the 1970’s when I was at the National Cancer Institute. We knew that our bodies’ immune systems could recognize some cancers as “foreign”, particularly melanoma and kidney cancer. Even though we had evidence that our bodies could recognize these cancer cells weren’t normal, our natural, “built-in” defense systems sometimes didn’t attack those cancers. The goal was to figure out how to make the immune system wake up and do its job. We … Continue reading →
As the American Society of Clinical Oncology (ASCO) convenes its annual scientific meeting in Chicago–where thousands of participants from around the world gather to learn about the latest advances in cancer research and treatment–we should not lose sight of the fact that the quality of life for patients during cancer treatment and survival is a critical part of what we must address as part of a holistic approach to the cancer care paradigm.
For decades cancer prevention and treatment has focused on the war metaphor: fight cancer, beat cancer, fight hard, whatever. The reality is that not infrequently people do everything right and they still die from this dread disease. Does that mean they didn’t fight hard enough? I don’t think so, and I suspect many of you agree.
But there is a yawning gap, and that is that we don’t pay as much attention to the … Continue reading →
It’s a headline that I suspect many thought would never be written, but it was-in the New Orleans Advocate on April 22:
“Harrah’s Casino in New Orleans gives patrons lollipops as it introduces smoking ban”
Six months ago, there weren’t many who thought this could happen, that the City Council of New Orleans would pass and the Mayor would sign a smoke-free bar and casino ordinance in New Orleans. But pass it they did, and now it’s the law.
The lesson from this incredible feat is that when we are committed to making our lives healthier and safer we can make it happen. It may be through smoke-free legislation or it may be through increasing tobacco taxes. But these laws and regulations make a difference for so many, from workers who work in these establishments, to those who patronize them and to those entertain us there such as the musicians in New Orleans, who were so much a part of making this happen.
I’m not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.
And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.
No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It’s not just about cancer, my friends. It will be coming to a primary care practice near … Continue reading →
As I write this, I am traveling from a meeting of the New Orleans City Council where testimony was heard regarding a new ordinance which would prohibit smoking in the city’s famed bars and the local casino.
As noted by Councilwoman LaToya Cantrell-who is the lead sponsor of the bill and who chaired the meeting–at the end of the hearing, it is a topic which has certainly engendered a lot of discussion among the residents of this iconic American city. Even when sitting in the airport the morning after the meeting I happened to overhear a gentleman near me intensely discussing the merits of the recommendations on the phone with a friend.
But loudest among the many voices were the sweet sounds that came from the musicians who provided testimony to the Council. There was no opposition from the music world: these artists earn their living inhaling the smoke of others, and they came out loud and clear about the need and benefit of being able to provide us entertainment in a healthier, smoke-free environment. As one of them noted a performer doesn’t have to consume a bit of every alcoholic … Continue reading →
What if you were sitting in the room with some of the best financial and scientific minds in the country and someone asked how many of you would be willing to contribute a modest sum of money to create a company with the potential of speeding up the evaluation of drugs that could revolutionize cancer treatment?
That was the opening question of a fascinating meeting I attended recently at the Massachusetts Institute of Technology, one where I didn’t want to leave my seat for a moment for fear I would miss another thought-provoking comment or idea.
The meeting was called CanceRX 2014, and for two solid days about 300 participants listened, debated, and engaged in discussion on how to make that scenario happen. No small task, to be certain. But in this era of ever increasing research discoveries of new treatment targets, it is clear that we need some innovative thinking to take what we learn in the laboratory to the bedsides of the patients we care for. And to make that happen we need as much “out of the box” thinking as we can muster. [more]