There’s a new kid on the block when it comes to determining which cancer therapeutic is best for treating a specific patient’s tumor. In the cancer world, the term that best describes this new discipline is “functional precision cancer medicine.” Functional precision medicine is the name given to doing research on living tissues of patients; living tissues that have been collected from the patient’s tumor during surgery and remain viable for future analysis. The operative term is actually “functional,” since this defines the act of testing living tissue to see what happens.
Remarkably, testing the individual cancer patient’s living tumor tissue before giving potentially toxic drugs has not been done before. But, now, a new day is dawning. A number of factors have come together to allow for the study of cancer at the individual level. These factors include the new awareness that each individual’s cancer is unique, and therefore responds differently than other cancers; the advances in information technology and big data management; the advances in a number of technologies in the biologic sciences that allow robotic manipulation of cells and reagents in a scaled, and multiplexed fashion; and, very importantly, the ability to keep tumors alive and unchanged in culture and in a frozen state.
As a surgical oncologist who has been engaged with cancer patients for more than 30 years, I am not enamored with the use of the term “precision” in the definition of this new discipline. I would prefer the word “individual” rather than “precision” when describing the application of new therapies to a given patient. Precision, as a term, has been closely associated with the study of the genomic characteristics of a tumor. While the application of genomics to cancer therapy has been shown to be useful, I believe it is a term that has been oversold. Much still needs to be learned about the workings of the cancer cell, the microenvironment around that cell, the immune system and the local interactions with other non-cancerous cells that appear to be hijacked from their normal roles. It is therefore probably still a bit presumptuous to call our management of cancer precise. Certainly, it is medicine that is intended to be precise in its benefit for the individual cancer patient. But, I would prefer the term “functional individual cancer medicine,” since that is exactly what it is. It is the functional analysis of the living cancerous tissue of an individual with cancer, with the hope of a better therapeutic response.
But, regardless of the words used in the definition, the idea of “functional precision medicine” is real. Although only a minority of the cancer medicine and cancer research communities are aware of this approach, sooner or later the tipping point will be reached. The direction is set, and a paradigm change is afoot. Within the next few years, cancer care will be for the individual, based on that individual’s specific, and unique, tumor, and immune system characteristics. Instead of killing every bit of the cancer tissue from the patient at the time of biopsy or surgery, for the pathologist to examine under the microscope, a significant part of it will be saved and kept alive. Each patient will then have a “functional” analysis of his or her living cancer tissue, to determine the best treatment option available. Instead of evaluating “biomarkers” that predict what happens with living cancer tissue by examining fixed, dead cancer tissue (as is currently done in pathology laboratories), we will actually study what happens to living cancer tissue, when it is exposed to a drug or combination of drugs or an immuno-oncologic agent.
This isn’t science fiction or stuff for tomorrow. The paradigm change has already occurred. Functional Precision/Individual Cancer Medicine is now being practiced in some departments at several locations around the world: Englander Institute at Cornell, Dana Farber, Fred Hutchinson, MDACC, FIMM in Helsinki, and probably others, of which I am not aware. Companies such as Helomics and Sengine are dedicated to this proposition. So, this ability to do research for the benefit of the individual patient is available today, but only to a few, fortunate patients, at a few places.
Until now. SpeciCare opens up this opportunity to any cancer patient, anywhere in the USA.
Our company, SpeciCare, is the gateway to this new industry, for the common man and woman. SpeciCare is also excited to acknowledge, and endorse, the mission and leadership of the Society for Functional Precision Medicine, a newly formed group, with the vision to move forward this new approach for determining the best therapeutic for individual patients. We will do our best to advocate for our joint mission of providing new tools to benefit the clinical care of the individual cancer patient.
You only have one chance to save your tumor tissue alive. Don’t throw it away.
Ken Dixon, MD