Success key No. 1: A team approach
At the 537-staffed-bed Oregon Health and Science University Hospital in Portland, the Knight Cancer Institute has begun treating patients using personalized medicine specializing in cancer care, with a multidisciplinary team of physicians and researchers, according to Alan Sandler, MD, oncologist and professor of medicine in the division of hematology and medical oncology at the institute.
OHSUH saw success from the advent of personalized medicine in its backyard years ago.
A hospital physician, Brian Druker, MD, was among the first to develop personalized medicine drugs at a time the hospital was already collecting tumor information. The drug, Gleevec, was approved by the FDA in 2001, and is used to treat chronic myelogenous leukemia, a blood cancer that strikes about 5,000 people a year, and other cancers. The discovery of the drug was based on a specific genetic signature. Its usage has been linked to long-term survival of patients compared to alternative therapy, and is considered more cost effective.
The discovery "changed the course of the disease, adding years to the patient's life. It is also a pill, as opposed to intravenous chemotherapy," says Sandler.
The Knight Cancer Institute includes a multidisciplinary team of physicians who review treatment options with patients, with one added element: Researchers are involved with personalized medicine. The physician teams work closely with the hospital's diagnostic lab staff to analyze a patient's tumor for potential genetic abnormalities that may help lead to appropriate treatment. The advanced diagnostic testing allows researchers to examine genetic differences in the cancer cells.
As an example of the personalized medicine approach, the cancer facility highlights the case of a woman who previously had lung cancer but was later diagnosed with a brain tumor as well. KCI researchers found that the same changes in the cells of the lung were involved in spurring the brain tumor. Subsequent testing identified the exact mutations unique to the tumor, within the cell, and indicated a genetic defect. Using that information, KCI began to use a personalized approach for her care, and tailored drugs for her specific needs.
For a series of patients, a wide range of genes is analyzed, with hopes of generating genetic profiles. Like many facilities, OHSUH has not released the number of patients involved in its personalized medicine program, nor has it defined outcomes yet. That will be resolved when clinical trials are completed, Sandler says. There are a "number of different approaches using molecular targeted therapy," he says. For each patient, within a few weeks after diagnosis, the hospital obtains pharmaceutical information about drugs that may be suitable. "We start with more traditional therapy and that way we haven't lost any ground while waiting for information," Sandler says. The hospital also has biorepositories that store cancer tumor samples for future treatment decisions.
"A number of patients don't have mutations discovered yet," Sandler adds. "For those that do, we have some medication for them. At this point, some 'abnormalities' lack effective therapy. That's where we have the emphasis on clinical trials."
One of the most significant clinical trials involving the institute is known as the I-SPY 2 trial, which is testing the possibility of new therapeutic agents for cancer compared to standard chemotherapy. The focus is on women patients with newly diagnosed, advanced breast cancer. As part of the process, researchers are using genetic or biological markers from individual patient tumors that will be screened for potentially promising treatments.
"We have scratched the surface,'' Sandler says. "The concept of personalized medicine takes on a number of different approaches, and one that is most topical now is using molecular targeted therapy," he says.