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Cancer front line / Cancer genomics could revolutionize treatment, but still developing

The Yomiuri Shimbun

A man who suffers from advanced lung cancer mimes a practice golf swing in Amagasaki, Hyogo Prefecture.

The Yomiuri ShimbunThis is the fifth and final installment of a series on cancer genomics to see what the present and future of the field look like.

“Unfortunately, we were unable to identify the gene mutation responsible [for your cancer].”

Hearing this news in July last year, which seemed difficult for the attending doctor to even say, the patient had felt a sense of distance or unreality. Turning to his wife, he saw her eyes tearing up and her face contorting.

The 52-year-old company employee, who lives in Hyogo Prefecture and is suffering from advanced lung cancer, had hung his hopes on a genetic analysis of the cancer. He thought if the genetic mutation could be identified, then effective treatment could be found. However, the result dashed his hopes.

The patient had received his diagnosis in May last year at the Hyogo Prefectural Amagasaki General Medical Center. “After hearing the result, everything around me seemed to become very dark,” he recalled.

“Will I die?” he had said to himself.

The faces of his wife and children — a son in his senior year at university and a daughter in her third year of high school — appeared in his mind.

“Let’s ask SCRUM-Japan to check for genetic mutations,” the doctor had replied. “We may be able to find a treatment that will suit you,”

SCRUM-Japan is a cancer genomic medicine research project focusing on lung cancer and digestive organ cancer patients examine 143 different genes associated with cancer, a number that had expanded to 161 as of April this year. Patients from about 200 different medical institutions across the country — mainly those from the National Cancer Center Hospital East in Kashiwa, Chiba Prefecture — participate in this project. If rare gene mutations are found in the tests, patients could be allowed to take part in a clinical trial of new treatment.

This kind of genetic analysis is a ray of hope for patients whose disease is progressing and have few treatment options left. However, in the overwhelming majority of patients tested, the genes behind the cancer are not found.

A total of 4,197 patients with lung cancer had participated in SCRUM-Japan trial genomic analysis over the period of four years and five months through June this year, according to the hospital. Genetic mutations were found in 14 percent of them, or 598 patients. However, the number of those who met requirements to go on to actually take part in clinical trials, including a certain level of physical condition, was even fewer at 134 patients, or only 3 percent of the total. The hopes of more than 90 percent went unmet.

Yasuhiro Fujiwara, deputy director of the National Cancer Center Hospital in Tokyo, clearly said: “You should not set your expectations too high for cancer genomics. It shows potential to revolutionize cancer treatment, but it’s still developing. We need to continue researching it.”

The lung cancer patient later seized an unexpected chance. It is not a medicine for a genetic mutation, but a new variety of cancer treatment medicine called Opdivo, which regulates the immune system. It was said to be effective in 20 percent of patients. In his case, it quickly had an effect. Whereas the pain caused by the cancer had previously made even walking difficult, he is once again able to enjoy his hobby of golf and even work normally.

Cancer was once a hopeless disease. Lung cancer was deemed especially difficult, and it was not so long ago that nothing could be done to stop it.

As we entered the 21st century, molecular targeting drugs were developed that focus their attack on the genes behind cancer, and patients who had previously been given only months to live found themselves given a repreive of years. Recently, immunotherapeutic medicine has also arrived. Progress toward effective treatment has been made gradually but steadily. Progress in cancer genomics is part of that.

“If this were five years ago, I would certainly not be alive now,” the Hyogo man said. “I can only be thankful for medical advances. I hope as many patients as possible can be saved just as I could be.”

His words echo the sentiments of many cancer patients.Speech

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