Jean-Charles Soria, MD


October 06, 2011

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Update on Personalized Medicine

Hello. I am Jean-Charles Soria, Professor and Lead Investigator in the Early Drug Development Program and Lung Cancer Unit at Institut Gustave Roussy in Villejuif, France. Welcome to Medscape Oncology Insights. Today I will highlight some of the important findings in personalized medicine presented at the European Multidisciplinary Cancer Congress (a collaborative meeting of the European Society of Medical Oncology [ESMO], the European Cancer Organization [ECCO], and the European Society for Therapeutic Radiology and Oncology [ESTRO]).

Personalized medicine is an important way to improve cancer care, cancer diagnostics, and, potentially, daily practice. We have heard at this meeting a superb scientific presentation by Jose Baselga[1] that has clearly demonstrated that the way we are developing new anticancer agents, including new molecular targeted agents, is not working efficiently. A better adaptation between the molecular reality of the tumor and the molecular reality of the experimental compound is absolutely necessary to increase the success rate of new molecular targeted agents. To do so, molecular portraits are needed. Functional imaging is needed. Sequential biopsies are needed.

Targeting the Challenges

Dr. Gordo Mills[2] from MD Anderson challenged that view, highlighting the multiplicity of the problems we could have with the personalized medicine approach. These include the difficulty of having patients agree to have biopsies, the difficulty in deciding what is the most relevant biopsy -- is it the primary tumor or is it the metastasis? -- and of course the challenges related to technology. What we see is limited to the capability of the technology cavalry that we have. When we consider a tumor having an oncogene driver, this might not be the only molecular abnormality. It can be jointly present with another tumor that the technology is simply not able to see.

Zeroing in on More Targets

We also had a beautiful presentation by Gary Palmer[3] from Foundation Medicine showing us that deep sequencing is now possible in formalin fixed paraffin embedded blocks with as little as 50 ng of DNA. That represents just 5-10 slices of 5 microns of the biopsy. With that technology, it was clearly demonstrated that most of the samples had a median number of 3 mutations, some of which had up to 8. Among all these mutations that were identified in colorectal cancer, half of them were deemed to be actionable for the potential benefit of the patients.

During that same session, Monica Arnedos[4] and Fabrice André's group from the Institut Gustave Roussy in Villejuif presented data on daily practice high-throughput screening in breast cancer patients. They used CG HRA and gene sequencing for PI3K, and they were able to demonstrate that in around a third of the patients actionable abnormalities were clearly identified. Half of the patients with those abnormalities enter clinical trials for potential benefit.

Biomarkers, Imaging to Predict Efficacy

We had very nice presentations on potential biomarkers to predict the efficacy of antiangiogenic agents, among which I would like to highlight data presented by Dr. Van Cutsem and Dr. Jayson[5] on the value of serum baseline vascular endothelial growth factor as a potential predictor for bevacizumab efficacy. This was suggested by 3 different trials that were developed with bevacizumab in pancreatic cancer, gastric cancer, and breast cancer.

Finally, Dr. Nathalie Lassau[6] presented elegant data on a new functional imaging technique called dynamic contrast-enhanced (DCE) ultrasound. This was a multicenter study in France with more than 500 patients, suggesting that early changes at 1 month with DCE ultrasound could potentially predict the survival of patients under a variety of antiangiogenic agents.

Closing Remarks

With that I would like to conclude and thank you for your attention during this edition of Medscape Oncology Insights. This is Jean-Charles Soria reporting from the 2011 ECCO/ESMO Multidisciplinary Cancer Congress Meeting in Stockholm, Sweden.


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