Cancer… It’s a Molecular Disease
Where is the war on cancer going to be won?
Front Line Genomics met with Nazneen Aziz, who lists among her affiliations: Chair for the Board of Advisors at Arizona State University’s Health Futures Council and Chair of the Board of Directors for Arizona Biosciences Organisation (AZBio). Her experience in personalised medicine, biomarkers, genetic tests and development of drugs for cancer means she is one of the best people in the industry to ask…
FLG “Over the years, we’ve seen a lot of initiatives and wars declared on cancer. How are we actually doing in that fight at the moment?”
NA “War was declared on cancer during the Nixon era, and a lot of effort has been made since then. However, the advances in the management of cancer patients has been minimal. In terms of overall survival of patients, there has not been much of a difference. The FDA now approves drugs that only increase the survival of patients by two months. That’s very dismal. That is the level of progress we have made from several decades ago”… “A new technology that was first published in 2005 called the Next Generation Sequencing (NGS) now allows us to feasibly sequence individual genomes and uncover the variability that could not have been done with the older Sanger sequencing”… “I believe that with NGS, now we are technologically equipped to deliver true personalised medicine, and what’s now being referred to as precision medicine”… “We are poised to do quite well in the war against cancer and approach cancer with an understanding that everyone’s disease is different.”
FLG “What kind of an impact are you hoping to see from very intensely directed genomic efforts, such as the Precision Medicine Inititative?”
NA “With President Obama’s Precision Medicine Initiative and with the cancer Moon-Shot Initiative, the goal is that it will lead to more and more patients with cancer being sequenced and the data being shared”… “Currently, cancer patients are being sequenced, in clinical laboratories within different hospitals and reference laboratories. However, the data is not being shared. The Precision Medicine Initiatives will hopefully lead to sharing of these data. Data sharing is a great concept but making it happen is an enormous culture shift and will need regulatory changes as well as infrastructure changes. When, and if, data sharing can transpire that is when our ability to research and advance knowledge will occur by understanding the commonality and the variability in different cancers. I am hopeful that is when we’ll really see the big benefits.”
FLG “Do you think bringing sequencing to point of care”… “might help data sharing?”
NA “I’m not sure. Currently, it is common for doctors to order molecular tests for one gene, or one mutation, to make a diagnosis. That report stays in the doctor’s office or in the pathology lab, and are not shared among clinical labs or hospitals. Therefore, if point of care sequencing devices makes its way into clinical practise the data from these devices needs to be stored in a centralised database and made accessible. A concerted effort has to be made before it helps in data sharing as there are many barriers that exist today including patient privacy laws and other regulatory barriers.”
FLG “What does success look like for you in the war against cancer?”
NA “I hope that in three to five years we’ll see a much broader recognition within the oncologist community that cancer is a molecular disease. An understanding that patients can have gastric cancer or lung cancer—both originating from the same gene being mutated. I am hopeful that the clinicians will approach cancer differently and consider genomic analysis at the baseline and also when a patient’s cancer relapses. Currently, this understanding is mostly within the oncologists with academic hospitals and but not so widespread within community hospitals. The war against cancer also means an advancement of our knowledge of the complexities of the biology of cancer. And what that knowledge will eventually lead to are many more cancer targeted therapies to be on the market and that all cancers becomes manageable as chronic diseases and ultimately the inherent fear associated with the word “cancer” is eradicated.”
Read the full interview with Nazneen Aziz here. She lists the two new technologies she is excited about and suggests the best ways hospitals can take advantage of precision medicine.