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Looking Ahead

February 1, 2016

We are living in an exciting time—where cancer is being forced to reveal its genetic tricks and give up the molecular underpinnings it has been secretly using to grow within our bodies and evade our drugs. Couple these insights from sixty years of basic science charting and painstakingly determining the roles that genes and proteins normally play in our cells, and we have an unprecedented view of how cancer cells are working against us.

We also now have the DNA sequencing tools in place to determine the combination of molecular changes that drive the growth of a particular patient’s tumour at the BC Cancer Agency. Many patient tumours may appear identical when initially presented in the clinic but look under the hood and there will likely be substantial molecular differences. 

Most importantly these differences will harbor the clues to whether a tumour will respond to a particular drug or not.  Interpreting these clues is a key challenge in cancer research and the basis of my own research at the BC Cancer Agency. I do see an era arriving soon where a comprehensive genomic analysis of a cancer will be available for those patients who require it and allow a truly personalized treatment recommendation for them. 

In the future, I believe that clinicians will be just as likely to talk of cancers in terms of the molecular changes that drive them and the drug sensitivities they possess than the part of the body from which they arose. One of the historical challenges has been that we have been treating cancers as simply “colon cancer” or “kidney cancer” without a full appreciation of the diverse differences that might exist at the molecular level. Over the years opportunities have been lost as promising cancer drugs have failed in trials because they only worked (perhaps astoundingly) in a relatively small fraction of patients. The questions that we can and should now ask is, what is it about that five percent of patients that could respond and why don't we simply identify their tumour’s molecular signature and treat them?

I believe that there are two fundamental things that a patient wants. Firstly, the patient wants access to the best possible health care. Secondly, and perhaps more subtly, the patient wants to know that their health care experience is being learned from and used to improve medical knowledge and practice.

The second point is particularly important in cancer care, as we are only now beginning to determine and collate the genetic sub-types of cancer and whether they respond or fail to respond to any of the battery of drugs available. To achieve this, we are going to need a new generation of computational and software infrastructure to store and analyze these data. 

One of my goals is to achieve this and allow us to learn from every patient at the BC Cancer Agency. To make further progress, the results from a single hospital are not going to be enough and we will need to share our data and insights nationally and internationally.

Those rare cancers that an oncologist may see only once in their career will become much easier to treat if we can access the genetic insights and outcomes from hospitals all across the world. Similarly, many drugs are effective in placing cancers in remission, but in the majority of cases resistant tumours will arise. 

While we have spent decades characterizing the tumours that naturally seem to arise, these drugs may induce completely new forms of disease—essentially forms of cancer that have never existed before on this planet.  Clearly, we need the ability to rapidly sequence, study and share the data on these new forms and determine the unrealized drug sensitivities lurking in their genomes.

In closing, I am reminded of the Chinese military strategist and philosopher, Sun Tzu, who lived 2,500 years ago.  His work “The Art of War” is considered a masterpiece and a definitive work on military strategy. If indeed we are waging a war on cancer, then surely to make progress we must heed his advice—“Know your enemy, know yourself”.