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Analyzing patients’ tumors, from the inside out

The experts on Stanford Medicine's molecular tumor board brainstorm new ways to attack individual patients' tumors at the genetic level.

People with advanced cancers -- those that have metastasized or progressed in the face of treatment -- may feel there's no hope. But physicians at Stanford Health Care aren't ready to give up on them.

In the latest, cancer-themed issue of Stanford Medicine magazine, I describe Stanford Medicine's molecular tumor board, which brings together a panel of experts to brainstorm new ways to attack individual patients' tumors.

From my article:

Having an open mind is crucial. Traditional cancer care categorizes cases based on the type of tissue involved -- is it in the lung, colon or breast, for example -- and the stage at which the cancer was diagnosed. Has it invaded surrounding tissues or metastasized to distant sites? How large is the primary tumor? What are the patient's clinical symptoms? ...

Stanford's molecular tumor board is filled with experts who want to look under the hood of intractable tumors and identify, at a genetic level, what makes them tick. Together, oncologists, pathologists, cancer geneticists and genetic counselors, informatics experts, and medical fellows and residents comb through a labyrinth of data points, including any mutations in a tumor's DNA sequence that could be targeted by existing drugs.

Sitting in on their meeting in December was a privilege. As I listened to their discussions about patients, it was clear how much the doctors cared about each person, and how determined the board, led by James Ford, MD, were to find new treatments.

As Ford, who directs Stanford's Clinical Cancer Genomics Program, explained for the article:

We can now sequence hundreds and thousands of DNA sequences within a tumor in a time frame that is achievable. And this group includes people very experienced in interpreting test results with lots of subtleties. Often, we will identify tens or thousands of individual mutations in one patient's tumor.

We need to decide: How do we prioritize these? Which are likely to be the driver mutations that the cancer relies on to grow? And, once we identify a potential targeted therapy, we discuss how to get that drug to the patient: Is there a clinical trial in which the patient could enroll? Might it be possible to get the drug for off-label use?

Ford added: "Our hope is that this type of approach will be successful not just for metastatic patients who don't have options, but that what we learn here might also help to bring this personalized oncology to newly diagnosed patients to increase cure rates and decrease the toxicities that often accompany traditional therapies."

Illustration by Gérard Dubois

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