New York Presbyterian

FALL 2014

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1 9 SHUTTERSTOCK w w w. s p i r i t o f w o m e n . c o m FA L L 2 014 S P I R I T O F W O M E N becoming a regular part of cancer diagnosis and treat- ment. With genetic counseling, a detailed assessment of the patient's genetic background is used to determine cancer causes and risks. "When you're testing all these tumors, you might find mutations, but some mutations could be something the patient had all along," Dr. Silbermins says. "The cancer they have and the genetic mutation might not be related. So then you want to know the patient's genetics, and the family's genetics, and test based on that. But as of now, there are very few places that have the capability to offer comprehensive genetic counseling." KEEP THINGS IN PERSPECTIVE Medical professionals say it's clear that genetically tar- geted chemotherapy offers promise, but its effectiveness can vary greatly depending on the type of cancer and the patient's circumstances. "Remember, the biggest reason why we are where we are in terms of cancer treatment is due to the benefits of standard chemo," Dr. Abou-Jawde says. "Don't just chase ads [for cancer treatment] that promise personalized medicine. We see cases where patients travel to different states to seek new treatments and just end up getting the treatment they could have gotten locally." Ultimately, the best course of action for a cancer patient seeking treatment is to find a good doctor and follow that physician's recommendations, he advises. "This new technology is good technology, but it's way too early to abandon standard treatments for it across the board," Dr. Abou-Jawde says. "If you do seek genetically targeted treatment, make sure you're with a doctor who is comfortable interpreting the test results and can plot a good treatment course." • G etting rid of cancerous cells without harming healthy cells has long been the holy grail of cancer treatment research. Today, genetically targeted chemo- therapy treatments are helping to make that goal a reality for more cancer patients. Cancer is the result of genetic mutations that cause previously healthy cells to grow in an abnormal manner, and these treat- ments specifically target the genes that have mutated. ASSESSING THE TARGET "All chemotherapy is genetically targeted in some respect," says Dr. Donald Busiek, a medical oncologist and principal clinical research investigator at St. Luke's Hospital in Chesterfield, Mo. "They're drugs designed to damage the DNA of malignant cells and kill them. Unfortunately, traditional chemo is not very specific and can also damage healthy cells." In certain cancers, however, researchers have dis- covered specific genetic mutations that act as cancer activators, and genetic testing is now a required step in the biopsy analysis. "There are some cancers in which research has been more on the forefront as far as these types of treatments," explains Dr. Rony Abou-Jawde, who is an oncology physician administrator affiliated with Heartland Regional Medical Center in St. Joseph, Mo. "The first that comes to mind is lung cancer. Research is to the point that we've identified specific genetic targets for treatment, but you have to test for them first." With breast cancer, Dr. Abou-Jawde estimates that between 60 and 80 percent of cases contain a target- able gene. The research that has been performed on ovarian cancer is less extensive, due to a smaller number of cases relative to more common cancers such as breast cancer, but some genetic targeting is also possible. PROMISING TREATMENT OPTIONS Because genetically targeted chemo is still in its infancy, many of the drugs in use have not yet received full Food and Drug Administration approval. As a result, many patients opt to take part in clinical studies centered on experimental treatments and drugs. "I think you're going to see an explosion of studies in the coming years," says Dr. Damian Silbermins, a medical oncologist at St. Mary's Medical Center in Huntington, W.Va. "A lot of this is going to change and evolve over time. It has the potential to change the industry, but we have a lot of ground still to cover." Dr. Silbermins foresees genetic counseling eventually Finding a clinical trial If you're interested in fnding out about clinical trials involving genetically targeted chemotherapy, the frst step is talking with your health care provider about your specifc situation. Te National Cancer Institute's Cancer Information Service can also provide detailed information about clinical trials that are currently accepting patients. For the latest on NCI-sponsored clinical trials and clinical trials by independent investiga- tors at U.S. and foreign hospitals and medical centers, as well as trials sponsored by pharmaceutical com- panies, go to the NCI's website at: http://www.cancer.gov/clinicaltrials.

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