Mar 22, 2016 9:00 AM

Dr. Siddartha Mukherjee
Dr. Siddartha Mukherjee

There are limits to precision medicine – the genome-mapping wave permeating health care these days.

And no one is more aware of the gap between technology and science than cancer doctors.

A panel gathered at Huntsman Cancer Institute (HCI) March 23 warned about the boundaries, even the dangers, of relying too much on “big data” to treat patients with uniquely variable diseases.

“We are at a point where we have a lot of data we need to churn into wisdom,” said Dr. Mary Beckerle, CEO and director of Huntsman Cancer Institute.

The data-driven approach to patient care guides everything from selecting embryos without the genetic mutation for cystic fibrosis to treating breast cancer patients with the BRCA1 gene.

 “Society is imploring us to practice precision medicine. We have to practice precision medicine,” said Dr. Siddartha Mukherjee, Pulitzer Prize-winning author of Emperor of All Maladies: A Biography of Cancer and assistant professor at Columbia University’s College of Physicians and Surgeons. And “we’re getting better and better at sequencing tumors and genomes of patients and prescribing risk to them.

“The big if – and it’s a big if – is how to apply precision medicine to them. Is there a way we can refine our analysis?”

For example, Mukherjee said, two women walk into a clinic. Both have breast cancer tumors that look identical under a microscope. One has 17 genetic variations; the other 84. They might share one gene in common. Each woman’s cancer will require radically different treatment under precision medicine. There is no one-size-fits-all.

“As we’re getting more and more information and there’s more and more hope, we’re turning every individual cancer into its own unique disease,” Beckerle said.

In some cases, science hasn’t caught up to the technology, said Dr. Alana Welm, an HCI investigator and oncological sciences associate professor at University of Utah School of Medicine. Doctors may be able to identify an actionable genetic mutation, she said, but be unable to find a tumor-suppressing drug to treat it.

The gap between the technology and science is frustrating for patients, Mukherjee said.

“Many, many patients will come in and have parts of their genome [mapped], expecting that information will lead to an actionable decision,” Mukherjee said. “Just because we know the genetic sequence of a tumor doesn’t mean we can do anything about it. Information does not translate into actionable information always. In fact, in typical situations, it does not.

“The rest of it is kind of molecular darkness.”

At the same time, Dr. Saundra Buys, Medical Director of HCI’s High Risk Breast Cancer Clinic and a professor of medicine, says, we tend to forget the vast majority of people may never require genome mapping.

Statistics say one in eight women will develop breast cancer in her life, says Buys. But if you factor out those with genetic mutations, including the BRCA1 and BRCA2 genes, those breast cancer risk projections would improve for most patients.

Figuring out how to weed out low-risk patients also should be a goal of precision medicine. “We’ve been paying a lot of attention to genes,” she said.

Which is why, Mukherjee says, he’s cautious about the push for “big data” – massive genome-mapping projects meant to spur further advancements in precision medicine. But trying to develop individualized chemotherapy drugs and radiation protocols for 100,000 patients would break the bank.

 “We talk about precision medicine as if it’s a given,” he said. “For most cancers, it’s an experiment. We are in the midst of a vast experiment, often without the best resources.”

Mukherjee calls himself a “small data person.” He says big data and small data need to work in tandem to really treat patients effectively, “before we make promises.” And he predicts a “hump of big data and reorganization.”

“We have to commit to that in a sensible way,” he said. “Otherwise, we just accumulate things without getting ourselves over the hump.”

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About Huntsman Cancer Institute at the University of Utah

Huntsman Cancer Institute at the University of Utah is the official cancer center of Utah and the only National Cancer Institute-designated Comprehensive Cancer Center in the Mountain West. The campus includes a state-of-the-art cancer specialty hospital and two buildings dedicated to cancer research. Huntsman Cancer Institute provides patient care, cancer screening, and education at community clinics and affiliate hospitals throughout the Mountain West. It is consistently recognized among the best cancer hospitals in the country by U.S. News and World Report. The region’s first proton therapy center opened in 2021 and a major hospital expansion is underway. Huntsman Cancer Institute is committed to creating a diverse and inclusive environment for staff, students, patients, and communities. Advancing cancer research discoveries and treatments to meet the needs of patients who live far away from a major medical center is a unique focus. More genes for inherited cancers have been discovered at Huntsman Cancer Institute than at any other cancer center, including genes responsible for breast, ovarian, colon, head and neck cancers, and melanoma. Huntsman Cancer Institute was founded by Jon M. and Karen Huntsman.

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