The debate around the use of genomics to guide fully personalised medicine for patients is one that has been raging for some time and I covered the most recent views from world leading experts here.
Chaired by Professor Andrew Tutt, Director of the Breakthrough Breast Cancer Research Centre, the debate brought together experts on the subject to put forward their opinion on genomic medicine for secondary breast cancer and ask if they think it’s hype or reality?
In a debate pitched to be as entertaining as a battle of gladiators in the Colosseum of Rome it’s no surprise that the atmosphere in room 3A of a grey-carpeted conference centre in Liverpool was no less electric then when Crowe slew Phoenix.
Holding the fort for ‘reality’ we had Professors David Cameron and Iain Macpherson, whilst digging in that it’s all ‘hype’ were Professors David Miles and Andreas Makris.
Before it began the audience pitched their votes with ‘reality’ coming out just slightly ahead of ‘hype’. With the stage set, the combatants launched into their talks and gave it their all to win the crowd over.
‘Genomic medicine is already here, it can’t be ignored’
Cameron and Macpherson put forward the case that genomic medicine is already the reality and we can’t ignore the advances that are happening. They stressed that the reality is that genomics is influencing how patients are diagnosed and treated and this reality is one which is true for all breast cancer patients. It was argued that there has been an exponential increase in genomic technology, major advances in targeted drug discovery and we have a deep understanding of cancer biology, all of which make genomic medicine a reality for breast cancer treatment.
All of these advances are part of a natural progression in breast cancer treatment so why should we now abandon this rational progression when genomic medicine is the next step in the evolution of cancer treatment? This would allow us to move away from a drug-centred treatment regime and towards a patient-centric approach.
‘One dumb tumour is smarter than ten oncologists’
Miles and Makris took to the stage to rebut the idea that genomic medicine is already here. They stated there is far too much hype behind the usability of the technology and its application to treating patients, hype which could be misleading to patients. As an example, the 100K Genome Project led to media hype that it was a ‘new hope for cancer cure’. The speakers debate that this puts a high expectation on the project when it’s not aiming to cure cancer, but rather to improve how we match individual patients to available treatments.
From a biological perspective, they argue that there needs to be a more realistic attitude towards the use of genomic medicine. David Miles made it clear that “one dumb tumour is smarter than 10 oncologists”. When a tumour is hit with a drug it’s often the case that the tumour adapts quickly and hijacks other biological mechanisms to keep surviving and growing. But how can we keep up with this rapid adaptation? Professor Makris said that you need to locate the ‘driver‘ mutation, the central weak point of a tumour, and attack that, rather than attacking any small weakness discovered by genomics. Taking the passengers out won’t stop the cancer bus, but taking the driver out could grind it to a halt.
The big result
Once the dust had settled and the duelling heavyweights had laid down their arms, the crowd was commanded to pitch their vote again. The result was 50-50, a figure which just highlights the complexity of this debate. With no side being able to claim themselves as outright victors we were left to soak up the compelling stories weaved by both sets of combatants.
So it seems that the debate is set to continue. However, encouraging discussions such as this gives people food for thought and hopefully inspires them to think of new approaches to tackling the issue of secondary breast cancer. Advances in technology and treatments are moving ahead at record pace and nothing is predicted to slow the train down. Breakthrough plans to be right there, continuing to fund world-class research into the causes and treatment of secondary breast cancer and working to ensure that whatever the outcome, we make it a reality.
Join the debate on Twitter at #NCRIbcdeb.
Dr Matthew Lam is Breakthrough Breast Cancer's Senior Research Officer.