If we want to win the race against cancer, we cannot rely solely on genomics-based testing, argues Senior Research Fellow Joe Olechno in an article that appeared in Medicine Maker.
“The potential of genomics is great but we need orthogonal techniques as well,” he writes.
Personalized medicine can be a misnomer, Olechno says, since therapy is often based on the responses of small patient groups and how a percentage of patients with the same mutation and similar cancer respond. Other problems he sees: DNA mutations do not always cause cancer, DNA analysis of tumor cells produce many false positives, and lab results vary.
In order to truly deliver personalized medicine, a patient’s potential therapy should be tested against his or her own tumor cells, Olechno says. As an example, he points to an ex vivo screening approach adopted by Labcyte collaborators at the Institute for Molecular Medicine, Finland (FIMM).
At FIMM, they isolate cancerous cells from a patient and then test those cells against hundreds of possible drugs – both singly and in combination - to see which are effective. Not only can they identify treatments that are promising, but they can also rule out drugs that look promising in theory but fail on cells ex vivo, and thus unlikely to work in the patient.
This can eliminate a futile round of chemotherapy, the benefits of which should not be understated, Olechno says. “No loss for the insurance company, no chemo-induced side effects for the patient, and no wasted time during which malignancy can further develop.” Combined with genomic analyses, this kind of ex vivo screening can further inform treatment design and drug discovery – or, in some cases, re-discovery, as Olechno highlights examples where drugs created for one purpose were found effective against other conditions.
While a few labs are following FIMM’s example, Olechno urges wider incorporation of functional testing into precision medicine efforts. He suspects that some labs are hesitant to employ techniques that fell out of favor in the 1970s. But he argues that instrumentation, assays and cell manipulation technology is much more powerful today than it was 30 or 40 years ago.
“I am far from Olympian, but I will beat you over a one-mile track if you hop the entire way. And right now, we are hopping when it comes to personalized medicine if we rely completely on genomics,” Olechno writes. “The combination of the ex vivo and genomics-based techniques brings a second leg to the race and running faster along this track is a boon to everyone: doctors, pharma companies, insurers, and – most importantly – patients.”