The first clinical case profiled at Foundation Medicine was from a male in his early 40s, never-smoker, diagnosed with lung cancer. His tumor was analyzed using FoundationOne®, a fully informative genomic profile that supports physicians in their treatment decisions. A novel gene fusion was identified as a driver in the growth of this patient’s cancer. Working in collaboration with colleagues at the Dana Farber Cancer Institute in Boston, Foundation Medicine showed that RET-inhibitors, a class of drugs already FDA-approved for use in kidney cancer and other diseases, showed activity in cancers with this type of alteration. These findings, and several other findings made in a subsequent clinical trial, were published in leading journals within a year (Nature Medicine and Cancer Discovery).
The speed of this scientific progression, from the discovery of a disease target to the demonstration of patient response in just one short year, is unprecedented in drug development history, which leads us to the question: How might every patient with cancer benefit from the latest science at the time of their treatment, particularly when it has historically taken a dozen years or more from the time a technology is proven to become integrated into routine care?
The paradigm of treating cancer based on where the cancer is located (for example, breast, colon, lung,) continues, but we also know now that cancers may be more accurately categorized by the underlying defects in the DNA (or, genomic alterations) that drive cancer growth. The genomic alterations can be targeted to personalize a patient’s treatment, often regardless of tumor type.
This year, at the 50th anniversary of the Annual Meeting, we are not only celebrating the achievements of the past and the possibilities for the future, we are seeing firsthand the incredible progress that is happening today.
We are seeing the realization of the promise of precision medicine as physicians’ treatment decisions are being influenced by the results of genomic profiling. The patients who have been treated with matched targeted therapies are showing encouraging responses. And newly identified genomic alterations from the ever-growing knowledge base of genomic data are paving the way for the development of more promising targeted therapies.
However, these advances come with great challenges. What does a doctor do with the information? How does a doctor choose among several targets? How do we choose a treatment for a patient when there is little or no published clinical evidence for a given tumor type? It is impossible for a practicing physician to keep up with the explosion in knowledge, and the existing paradigm of population-based clinical trials is far too slow to keep pace with a field that is moving toward individualized treatments.
Information technology must be the key enabler. The exchange of information across the global cancer community is critical for success in the fight against cancer, allowing physicians to access, share and analyze genomic and clinical data for their patients to help inform treatment decisions. Technology will enable the incorporation of what is learned every day in clinical experience into our collective knowledge and accelerate the field’s move toward precision medicine. In other words, when genomic information for a given patient is combined with information about the patient’s clinical history, and mined along with thousands of other patients, patterns will emerge that will help physicians achieve a deeper understanding of cancer and potential treatment responses.
As we celebrate the 50th Annual Meeting, I cannot help but look forward and imagine a brighter future for patients with cancer: a future in which every patient with cancer can have their tumor comprehensively analyzed, regardless of whether the patient is being treated, at a major cancer center or in a rural community practice; a future in a which pathologists, oncologists and their patients benefit from the knowledge gained from each patient who has come before them; a future in which each patient’s clinical data is integrated into a larger knowledgebase with other real world data, aggregated with the latest scientific and medical knowledge, and synthesized to inform real-time decision making; and, a future where each patient’s treatment is informed by a deep understanding of the genomic and other molecular changes that contribute to their disease.