The Dawning of Democratized Cancer Care

Scientific advances in molecular profiling are democratizing cancer care, ushering in a new era of personalized cancer therapy.

Just as democratic societies empower people at all levels, not only the elite, the latest and best cancer care is now available to any cancer patient, regardless of location. New national studies like TAPUR (Targeted Agent and Profiling Utilization Registry) by the American Society of Clinical Oncology (ASCO) and the National Cancer Institute’s MATCH (Molecular Analysis for Therapy Choice) trial offer patients with advanced cancer access to best-in-class molecularly-guided therapy in their own communities.

Now patients with every type of cancer all over the country, including patients in underserved rural settings, no longer have to leave their family and community support systems and travel long distances to urban cancer centers like MD Anderson Cancer Center Houston, Texas; Memorial Sloan-Kettering Cancer Center in New York City; or Kimmel Cancer Center at Johns Hopkins in Baltimore, Maryland. The latest and best cancer care is available to patients right in their own home towns, no matter how remote the location or modest the socioeconomic level of the patient.

Large, innovative initiatives like TAPUR and MATCH are not designed to study breast, lung, colon, pancreatic or any other site-specific cancer. They are studying every kind of solid and liquid tumor, targeting the same molecular defects with the same therapy. These trials are building on the growing sense that many research scientists have had that cancer trials need to dramatically change based upon the data coming in: No longer should we be designing trials solely based solely on site of origin, but trials should now be designed based on the molecular defects that are shared across tumor types.

We are making progress in cancer care—huge headway with some cancers—but we have a long way to go in treating tumors overall. Cancer is still the number one killer. The standard practice of one-size-treatment-fits-all doesn’t work and is hopelessly obsolete. Ninety percent of patients treated with standard chemotherapy don’t respond well. Many patients are living longer, but we can’t be fooled by statistics: even if a drug increases the survival rate by 70%, it may still mean the patient lived 15 months, instead of eight. That’s statistically significant, but it still means that most patients with metastatic disease eventually develop resistance to the therapy, progress and eventually succumb to the disease. Even when “miracle” drugs show breakthroughs, we see patients return in only a few years with recurrent, resistant disease. Is that how we want to continue to define success?

TAPUR and MATCH are helping spread the knowledge that everyone’s cancer is unique at the molecular level, that cancer is defined by molecular defects in an individual and not by the site of the tumor—and that is how it should be treated. The tumor merely resides in the breast, colon, lungs, prostate, pancreas and other locations in the body, and treatment needs to be targeted to abnormalities at the molecular level.

Personalized medicine companies recognize this. They are helping to democratize cancer care by providing the pipeline between patients and their oncologists and the pathology labs. The field is moving beyond a genomics-only approach to cancer and incorporating information about the proteins and protein pathways into the molecular profiling. After all, while the DNA is the information archive, it is the proteins that do all of the work and are the drug targets themselves. To reduce the workload of oncologists and speed treatment for patients, personalized medicine firms are becoming a turn-key personalized cancer therapy solutions provider—a single enterprise that “bird-dog” the logistics of obtaining tissue samples, distributing them to the myriad of genomics and proteomics molecular testing labs, and compiling and aggregating the results along with the patient-specific medical treatment history to produce a personalized report that enumerates the best treatment options available for the oncologists’ patients.

Evolving technology, proliferating players in the personalized medicine arena and the commercialization/commodization of molecular testing services are dramatically reducing costs of molecular analyses, and further democratizing cancer care by increasing access to the latest treatment for patients. Barriers persist, however, and there is still much work to be done to fully democratize cancer care.