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US tries genomic profiling to treat cancer

The Sacramento Bee--A national lung cancer trial launched earlier this summer with the help of a UC Davis oncologist has the potential to dramatically affect the way cancer drugs will be developed in the future.

The trial, called Lung-MAP, puts a cancer-fighting approach into action that uses genomic profiling. This involves testing a patient's tumors for “bio markers,” or genetic identifiers, that can help physicians determine which genetically targeted drugs will work for them.

The current course of treatment for lung cancer presents patients a range of therapies, some toxic, that are not targeted for that individual's cancer. Elizabeth Lacasia, a stage 4 lung cancer patient and active support group participant at the Bonnie J. Addario Lung Cancer Foundation in the Bay Area, called it “throwing spaghetti on the wall to see if something sticks.”

When Lacasia was diagnosed in 2006, her oncologist did not consider genomic profiling a reliable option because of its newness. After six tough and not-so-successful rounds of chemotherapy, Lacasia eventually moved to the care of Dr. David Gandara, director of the UC Davis Thoracic Oncology Program and a lead researcher on the new Lung-MAP trial. He used genomic profiling to find a combination of drugs that stabilized Lacasia's cancer and prevented new growth for more than four years.

What Gandara did for Lacasia is now possible on a large scale through Lung-MAP, which anticipates testing 1,200 patients nationwide each year for up to 200 genetic idenifiers.

“It just has to go this direction,” Lacasia said. “It makes complete sense. Cancer has a certain mutation, and they have a drug for it, why not give that patient that drug? Now they're stepping back and saying lung cancer is a unique personal disease, so we should treat it on a unique personalized basis.”

The clinical trial, which launched nationally June 15, matches the patient's genomic profile with one of five newly developed cancer-fighting drugs. If a treatment proves successful through testing, the Food and Drug Administration will register that drug and its bio marker, Gandara said.

Researchers behind the trial believe the ability to screen more patients for more drugs at once will lead to more efficient approval of genetically targeted cancer therapies.

About 25 percent to 30 percent of all patients with non-small cell lung cancer, the more common of the two major types of lung cancer, will be eligible for the trial. Lung cancer is the leading cancer killer of both men and women, according to the American Lung Association.

Four of the five drugs being tested in this trial are targeted at specific genetic markers. Patients with the right profile for any one of those four drugs will be placed accordingly in a subgroup of the trial, while those who meet criteria for the study but lack the appropriate bio marker will be placed in a fifth “non-match” subgroup, said Gandara. Patients in the fifth group will receive an experimental anti PD-L1 treatment, which aids the immune system in recognizing and fighting cancer and is not reliant on genetic markers.

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