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  • Dr. Robert A. Nagourney, MD

Most Dangerous Words a Cancer Patient Can Hear: "We Do the Same Thing"

Cancer patients who seek our functional profiling EVA-PCD test frequently ask their doctors for assistance. Responses can vary.

There is however a middle ground that we describe as “damning with faint praise”.

With this, the patient is led to believe that their physician will process the tissue in a timely manner and it is only at the last moment that the unsuspecting patient is apprised that the tissue processing will not go forward.

On the one extreme is enthusiastic cooperation and at the other, outright refusal. Thankfully the latter is becoming less common as functional (3D culture) techniques are rapidly gaining traction in the scientific community.

Those physicians who refuse outright are at least honest and provide the patient a stark choice: To either follow their instincts and seek the assistance of a likeminded physician who will cooperate or to forgo functional analysis entirely. The choice is theirs.

It is the physician who at first agrees but then fails to follow through that poses the greater risk. By then it is too late to reverse course. Once the patient is in the recovery room or the biopsy has been fixed in formaldehyde it is too late to go back and set things right. This is because the cells must be processed fresh and alive if they are to be sent to our laboratory for testing.

To defend their actions (or inactions) a growing number of physicians, who only a few years ago would have dismissed the concept of personalized cancer therapy out of hand, now clamor to explain that they “Do the same thing”.

But do they? The answer is a resounding No!

Genomic Testing Is Not Accurate In Finding The Right Treatment

These physicians, found at many medical centers, universities and biotech companies offer a very different approach based on gene-profiling and genomics.

There is nothing wrong with genomics per se.

It is exciting, technically advanced and certainly popular based upon the $10 billion spent annually in the US each year on these tests alone.

What genomics is not, however, is accurate for drug selection except in relatively small number of cancer patients who carry unique druggable targets. These targets have names like EGF-R, ALK, ROS and BCR-abl. When they are found they provide brilliant opportunities for therapy and we all use them wherever they apply.

It’s just that they don’t apply very often.

You see, it is a distinct minority of cancer patients who actually carry the “targets” for these “targeted agents”.

More importantly, many “targeted agents” work in patients who do not carry the “target”.

This is called an “off target” effect and is referred to by people in the drug development field as a "dirty drug" effect meaning it doesn't "cleanly" hit the target. Whether this is the reason or something entirely different, we absolutely cannot afford to miss patients for active treatment because their genes don’t fit.

Modern oncology has moved forward far too slowly as we have relied exclusively upon genomic analyses as the only platform for treatment selection.

While it is an interesting point of discussion to examine why gene-based programs have fallen short, no one can deny that, beyond a small collection of well described and well characterized targetable mutations, most gene profile techniques do NOT provide actionable information.

It is, therefore, disingenuous for physicians to say that they “do the same thing” as we do. They clearly do NOT.

They offer the static genomic information that can identify mutations, insertions, deletions and amplifications but cannot examine the biological impact of gene expression. These static platforms cannot inform us on the interaction between genes nor why and how normal genes behave in abnormal ways.

Only functional analyses can provide real-time biology and inform us in clinically relevant ways. Functional approaches interrogate the cancer at the level of the phenotype (Biology) and are completely and utterly different from studies at the level of the cancer genotype (DNA).

Importance of First Line Treatment

We know that cancer is at its MOST curable when it is first diagnosed and treated. That is when treatment decision should be made based upon sound biological information.

The Informed Patient:

Cancer patients today represent an engaged, self-empowered population who scour the internet, educate themselves and take charge of their illness. These are the patients who seek our care and assistance. These are the patients who can benefit from novel drug combinations, intelligent drug sequences and, sometimes unexpected applications of existing drugs and combinations.

These patients must steel themselves against the misinformation regarding functional analyses and may even find it necessary to educate their physicians about the role of these technologies in cancer medicine.

Cancer is demonstrably more complex than its genes and we know that genomic analyses provide only a thin veneer of information regarding drug choice and sequence.

At the leading institutions in the world the most sophisticated genomic investigators are coming to realize that there is more to cancer than the static information provided by gene arrays.

While this understanding of cancer complexity slowly filters down from the scientists to the treating physicians, patients should not be fooled by the suggestion that these institutions "do the same thing" as we do.

As always, I appreciate your thoughts and comments.

Dr. Robert Nagourney, has been internationally recognized as a pioneer in cancer research and personalized cancer treatment for over 20 years. He is a TEDX SPEAKER, author of the book OUTLIVING CANCER, a practicing oncologist and triple board certified in Internal Medicine, Medical Oncology and Hematology helping cancer patients from around the world at his Nagourney Cancer Institute in Long Beach, California. For more info go to NAGOURNEYCANCERINSTITUTE.COM

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