Cancer Fighters Thrive

WINTER 2013

Cancer Fighters Thrive is a quarterly print and online magazine bringing readers practical, innovative and inspirational information about cancer treatment and survivorship.

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RESEARCH TODAY PUT SIMPLY, GENOMICS IS A WAY OF "FINGERPRINTING" A CANCER TO IDENTIFY UNIQUE MUTATIONS OR CHANGES IN THE DNA AND POTENTIALLY IDENTIFY WHAT IS DRIVING THE CANCER'S GROWTH. cancer is different. Two patients who have identical cancer diagnoses may have tumors that look completely different at the molecular level. "We have begun to realize that cancer is a disease of a genome," explains Sramila Aithal, MD, Medical Oncologist at CTCA in Philadelphia, Pennsylvania. "Each cancer or tumor has its own genetic expression. Understanding these genetic changes is helping us understand how cancer develops and is best treated." Put simply, genomics is a way of "fngerprinting" a cancer to identify unique mutations or changes in the DNA and potentially identify what is driving the cancer's growth—which in turn can reveal unique and targeted ways to fght the cancer. It is sort of like cracking a secret code and then using it to solve a riddle: What is the appropriate way to treat this cancer? "Genomic analysis allows us to take cancer diagnosis to a different level," explains Dr. Citrin. "It used to be that cancer was simply staged: how big is it and where is it in the body? Now we're moving from simply staging cancer to identifying molecular subtypes—and we're fnding that different treatments do seem appropriate for different cancers." cfthrive.com According to Dr. Citrin, genomics provides two main advantages for patients. First, it can provide a more accurate diagnosis of the cancer, which can then guide treatment decisions. Patients with a favorable prognosis may be able to avoid unnecessary treatments. Patients with an unfavorable prognosis may be offered more-aggressive treatment. Second, if doctors can identify specifc genetic alterations in a tumor, they can often use more specifc, targeted treatments to treat the cancer. an individual's breast cancer enables doctors to customize treatment to target the specifc characteristics of the cancer. Women with HER2-positive cancer will beneft from treatment with Herceptin, whereas those with HER2-negative cancer will not. Similarly, women with ER-positive cancer may beneft from hormonal therapies designed to suppress or block estrogen. What's more, there are two genomic tests—Oncotype DX® and GENOMICS AND BREAST CANCER specifc breast cancer and predict its behavior. "These tests can tell us if a cancer is more likely to be aggressive, in which case it will require more-aggressive treatment," Dr. Citrin says. Breast cancer is an excellent example of genomics at work. "We now know so much information about the biology of breast cancer," Dr. Aithal says. "There are different types and subtypes of breast cancer, and this leads to information about the prognosis and the behavior of the cancer and even gives us an idea about what treatment options might be best." In fact, breast cancer treatment has evolved so dramatically in the past 10 to 20 years that genomic testing is now fundamental to the treatment of the disease. No longer is a woman simply diagnosed with breast cancer; now the cancer is identifed as either estrogen receptor– positive (ER-positive) or ER-negative and HER2-positive or HER2-negative. HER2 is a specifc abnormality present in about 20 percent of breast cancers— and was one of the frst gene targets to be identifed in cancer. The discovery of HER2 led to the development of the targeted drug Herceptin® (trastuzumab), which targets the abnormality, thereby suppressing cancer growth. Understanding the genomics of MammaPrint—that are designed to examine the genetic structure of a GENOMICS AND OTHER CANCER TYPES The genomics of breast cancer may get the most publicity right now, but that is changing as we learn more about the genomics of other types of cancer. Dr. Citrin explains that there are examples of specifc genetic abnormalities—which represent targets for the targeted agents— in several other types of cancer, including colon cancer (EGFR or HER1), lung cancer (KIT) and melanoma (BRAF). As such there is a variety of corresponding targeted agents designed to treat each of those genetic abnormalities, including Gleevec® (imatinib), Erbitux® (cetux® ® imab) and Zelboraf® (vemurafenib). "Colon and lung cancer are two good examples that illustrate the use of cancer genomics," Dr. Panicker says. "In advanced lung cancer, the presence of certain genomic abnormalities in the cancer cells leads us to choose certain winter 2013 | cancer fighters thrive 39

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