GRACE :: Cancer Basics

Cancer 101

Cancer Ouija Boards, Umbrellas, and Baskets: The Evolution of Genomic Oncology

Share

Cancer treatment is in the midst of a transformation in real time.  Genomic testing of a tumor– looking for a wide range of dozens to potentially hundreds of markers at a time — is moving quickly from bleeding edge to mass adoption, at least in the US. This change is partly driven by ever-changing data and ever-changing clinical experience, partly driven by the general promise felt by patients and clinicians alike that new information will lead to vast improvements in our understanding and therapeutic options, and (lest we be naïve) partly driven by marketing from institutions and diagnostics companies who stand to gain by promoting this work.

That there are potential gains is undeniable – regardless of what the future may bring, even today it is a tangible gain to avoid missing the immediately actionable findings such as an EGFR mutation (for someone with  non-small cell lung cancer (NSCLC), for instance), but it can find many less common but clearly “actionable” mutations ranging from HER-2/neu to BRAF or a few others that are now mentioned in the guidelines developed by the National Comprehensive Cancer Network (NCCN) that typically lead to insurer coverage of the treatments recognized as effective for these rare mutations, which range from <1% to 3-4% of the lung cancer population.

But these tests are not going to offer only unmitigated positive opportunities. Aside from the cost of several thousand dollars per tumor profile performed, the results of these profiling tests most often reveal not a clearly actionable mutation, but one or more rare mutations that are accompanied by a synopsis of lab-based suggestions for unapproved and clinically untested options in that particular tumor type from the testing company. While a patient and their oncologist may say that they will ignore treatment options that are poorly studied and essentially just wildly speculative (there is a rather weak correlation between cancer treatments that work in the lab and those that are safe and clearly active in human cancer patients), that’s easier said than done. Instead, the molecular results often lead oncologists to be tempted to practice the black art of using the profile as a “medical Ouija board” to cobble together a treatment plan with no good clinical evidence to support it, all too often bypassing the treatments that are well established as helping improve treatment options in thousands of cancer patients with that tumor type. 

Ouija Board

Continue reading


The Spectrum of Cancer Progression (50 Shades of Progression)

Share

Here’s a general summary of a thoughtful approach to how we might assess progression of disease, recognizing that it isn’t just a simple matter of a “yes/no” question of progression or not.  

And for those who want the pdf to print, here it is: 50 Shades of Cancer Progression

Feel free to leave questions. comments, objections, etc. here.I hope it’s helpful.

 

 


How a Cancer Adapts: Key Clinical Implications from the Evolution of an Advanced Cancer

Share

Key Clinical Implications of how a Cancer Evolves from H. Jack West

The associated, printable pdf is here.


Dr. Larry Einhorn: What is Your Opinion of Patients and Caregivers Searching the Internet for Information?

Share

Dr. Larry Einhorn, Distinguished Professor of Medicine at Indiana Univ and former ASCO president, discusses the trend of patients consulting Dr.Google – finding information of varied quality on the internet.


Dr. Larry Einhorn: Are You Optimistic That a Supercomputer Such as Watson Will Be Able To Improve Cancer Care?

Share

Dr. Larry Einhorn, Distinguished Professor of Medicine at Indiana Univ and former ASCO president, gives his view on whether a supercomputer such as Watson will be able to use complex algorithms to improve cancer care.


Ask Us, Q&A
Cancer Basics Expert Content

Archives

Share

Immunotherapy Patient Forum 2014 Videos

 

Lung Cancer Awareness Month Information

 


GRACE Website Rebuild

Share

Join the GRACE Faculty

Lung/Thoracic Cancer Blog
Breast Cancer Blog
Pancreatic Cancer Blog
Bladder Cancer Blog
Head/Neck Cancer Blog
Kidney Cancer Blog
Share

Subscribe to the GRACEcast Podcast on iTunes

Share

Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon

Subscribe to
GRACE Notes
   (Free Newsletter)

Other Resources

Share

ClinicalTrials.gov


Biomedical Learning Institute

PeerView Press - Curriculum-Based Learning Activities