Gene tumour boards guide cancer care
Doctors were just guessing a decade ago when they gave Alison Cairnes’ husband a new drug they hoped would shrink his lung tumours. Now she takes it too, but the choice was no guesswork. Sophisticated gene tests suggested it would fight her gastric cancer, and they were right.
Cancer patients increasingly are having their care guided by gene tumour boards, a new version of the hospital panels that traditionally decided whether surgery, radiation or chemotherapy would be best. These experts study the patient’s cancer genes and match treatments to mutations that seem to drive the disease.
“We dissect the patient’s tumour with what I call the molecular microscope,” said Dr. Razelle Kurzrock, who started a board at the University of California, San Diego, where Cairnes is treated.
It’s the kind of care many experts say we should aim for — precision medicine, the right drug for the right person at the right time, guided by genes. There are success stories, but also some failures and many questions:
Will gene-guided care improve survival? Does it save money or cost more? What kind of gene testing is best, and who should get it?
“I think every patient needs it,” especially if cancer is advanced, said Kurzrock, who consults for some genemedicine companies. “Most people don’t agree with me — yet. In five years, it may be malpractice not to do genomics.”
Few people get precision medicine today, said Dr. Eric Topol, head of the Scripps Translational Science Institute. “The only thing that’s gone mainstream are the words.”
If you have a cancer that might be susceptible to a gene-targeting drug, you may be tested for mutations in that gene, such as HER2 for breast cancer. Some breast or prostate cancer patients also might get a multi-gene test to gauge how aggressive treatment should be.
Then most patients get usual guideline-based treatments. If there’s no clear choice, or if the disease has spread or comes back, doctors may suggest tumour profiling — comprehensive tests to see what mutations dominate.
Newer tests that detect tumour DNA in blood — liquid biopsies — are making profiling more common. The tests cost about $6,000 and many insurers consider them experimental and won’t pay.
Gene tumour boards analyze what the results suggest about treatment. They focus on oddball cases like a breast cancer mutation in a colon cancer patient.