Much of the progress that has been made in decreasing suffering and death from cancer has been brought about through approaches that are directed at treating a population of patients rather than individual patients. Such solutions provide benefits to many people but not everyone.

Classic examples include PAP smears, smoking cessation programs and the use of radiation therapy for many cancers. More current examples include human papilloma virus (HPV) vaccination programs, which target cancer of the cervix, and experimental population-based initiatives to remove fallopian tubes during non-cancer related surgeries to prevent some ovarian cancers. 

"Within weeks of treatment with the blood pressure drug, Keating’s tumour was rendered nearly undetectable. This unexpected and unusual treatment approach led to a dramatic, sustained and lifesaving response."

Breakthroughs in cancer treatment

Although such population-based approaches maximize impact, they do not account for the unique, genetically-determined individuality that influences one’s risk of developing cancer, or for how treatments are individually tolerated and how cancers that appear to be similar through the microscope can be genetically distinct and respond to different treatments. Technological breakthroughs in genomic sequencing make it possible to use increasing amounts of information derived from analysis of cancer and normal tissue from patients to help guide clinical decisions.

Ultimately the goal is to match patients with the treatment plans that reflect their individuality and the specific vulnerabilities of their cancers. Two projects in British Columbia, the BC Cancer Agency’s Personalized Oncogenomics Program (POG) and Contextual Genomics’ National Access Project, are using distinct but complementary approaches to maximize the benefits from the personalization of cancer care.

Using technology to treat metastatic cancers

POG is a groundbreaking study where an analysis of similar scale to the human genome project was conducted on both tumor and normal samples from selected patients with metastatic cancers. Over 150 patients have been studied and the approach has led to new ways in which oncologists and scientists can work together to use large data sets to help patients with their immediate needs.

This aspirational yet very expensive approach to informing patient choices has the potential to profoundly change oncology practice and has already saved lives. The best example is Trish Keating, who was diagnosed with colorectal cancer and underwent five years of treatments including chemotherapy, surgery and radiation therapy. Her disease was then classified as incurable and terminal.

After enrolling in POG’s program, Keating’s tumour was sequenced, revealing a gene that over-expressed a protein that was potentially causing cancer growth. Importantly, a drug — normally used to treat high blood pressure — was available that inhibits the protein in question. Within weeks of treatment with the blood pressure drug, Keating’s tumour was rendered nearly undetectable. This unexpected and unusual treatment approach led to a dramatic, sustained and lifesaving response.

Bringing low costs to DNA testing

Contextual Genomics, a Vancouver-based clinical genomics company, is taking a different approach and hopes to improve cancer care by offering pragmatically designed low-cost assays to as many cancer patients as possible. “It could be said that we are going to maximize the impact of DNA testing in cancer through taking a Volkswagen as opposed to a Rolls Royce approach,” says CEO Chris Wagner. Contextual Genomics is working with the BC Personalized Medicine Initiative and oncology groups across Canada on a National Access Program through which free testing will be offered to up to 2,000 patients.

“This will remove geography as a barrier and source of inequitable delivery from today and tomorrow’s cancer genomics tests,” says Wagner. Both personalized approaches have the promise of empowering patients and their caregivers to make more informed cancer treatment choices that are safer, more effective and prolong a high quality of life.