Recently, President Joe Biden announced a new federal goal to reduce the cancer death rate by at least 50% over the next 25 years. It’s a bold goal and one that I applaud.
According to the CDC, over the past 20 years, cancer death rates have fallen by 27%, from 196.5 to 144.1 deaths per 100,000 population. That’s the good news. Now the bad: In 2022, you’re no more likely to survive five years with advanced solid cancer like pancreatic or lung cancer than you were when my 1955 Model 41D Buick Special rolled off the line. assembly in Detroit.
Despite this sobering update on where we really are, I was very encouraged by some of President Biden’s comments. His administration rightly targeted the real potential of combining existing drugs for more effective cancer treatments. This has been underused, but has great potential if applied correctly.
Like Biden noted, we need to be able to determine which combinations of treatments work best for a particular person. As things stand, Biden said, we know too little about why a treatment works in some patients and not in others with the same cancer diagnosed.
The President’s accomplishments are commendable and dovetail nicely with the successes we have had in using human tumor tests to select the best chemotherapy drugs and combinations for each patient.
As the president said, drugs that work for one patient may not work for another, even if both patients have the exact same diagnosis. Therefore, each patient should be tested to select the most effective and least toxic drug regimen for that individual before starting treatment. This is an approach the cancer industry must now take.
In order to determine the best combination or sequence of drugs, I believe the cancer industry should apply analyzes of human tumor explants like our ex vivo analysis of programmed cell death. This provides a dynamic assessment of cancer cell response by using each patient’s live cancer cells to select chemotherapy drugs. Although the concept may seem new to some, we have successfully applied this technique to over 10,000 patients, many with hard-to-treat cancers, and doubled their chances of a response.
One of the reasons this works, as the president noted, is that every cancer patient is unique, and the response to treatment is vastly different from person to person. When patients are treated without testing, treating physicians must rely on general guidelines and protocols that cannot capture the individual characteristics of each patient.
Ex vivo analysis of programmed cell death is markedly different from the tests offered by most medical centers that rely on DNA profiles known as genomic analyses. These use the patient’s chromosomal material to look for mutations and other changes in each patient’s genetic makeup that could guide drug selection. Although the concept is attractive, in reality only a minority of patients have genetic changes that can be used for therapeutic purposes.
Every human cancer reflects all of its genes, both mutated and normal, acting together to create what we recognize as a malignant tumor. Only functional analyzes can capture every patient’s tumor in real time and provide information that can inform drug selection and treatment decisions.
In a study we conducted in metastatic lung cancer where the average response rate is 30% with traditional generic treatment, patients had a response rate of 64.5% (p
The role of laboratory and functional profiling is to ensure that the most effective and least toxic treatments are selected the first time. This improves the likelihood of response and may help avoid toxic treatment choices when other, milder drug combinations appear to be effective.
Widespread application of this technology has the potential to improve patient outcomes, reduce costs, limit futile care, and streamline drug development. We agree with President Biden that we need to change the way we treat cancer. Analyzes of human tumor explants may well be the answer the president is looking for.
Photo: Julio C. Valencia via the National Cancer Institute