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Twitter chat on genomics and precision medicine

Andrew Poklepovic, M.D.

Recently, the National Cancer Institute hosted a Twitter on “Genomics and Precision Medicine in Oncology.” VCU Massey Cancer Center medical oncologist Andrew Poklepovic, M.D., who is also a member of the Developmental Therapeutics research program at Massey and assistant professor in the Division of Hematology, Oncology and Palliative Care at the VCU School of Medicine, weighed in as the moderator posed a series of questions. Below is a recap of the chat. Some of the responses have been slightly altered to provide context that could not fit into the original 140-character tweets. Be sure to follow @VCUMassey on Twitter to keep up with Massey’s latest groundbreaking research and clinical trials, learn about patient and caregiver resources and find out about volunteer and philanthropic opportunities while connecting with others who share similar interests and life experiences. 

Cancer is fundamentally a disease of the genome. What does this mean?
Genes encode the production of proteins, which control normal processes of a cell.  When genes mutate, these processes go haywire. As an example, proteins signaling cell growth become continuously active, leading to uncontrolled cell division.  At the same time, other proteins that enable cellular death lose their ability to function, and the mutant cells no longer die when they are supposed to. This leads to cells that do not die off and grow uncontrollably, leading to tumors.  There are many more genes involved than just these two examples, and the extent of the complex interactions of these mutant proteins is still being worked out.

How is cancer genomics shaping precision medicine?
If you identify the broken gene driving the cancer and can target that gene with a specific medicine, you can disrupt the cancer. Some cancers will have a mutation, others won't. You would only use specific medicines to target cancers with that mutation.

What are some examples of precision cancer medicine already in use?
There are many important ones in lung cancer. There are also drugs targeting EGFR mutations, ALK mutations, etc. The first drug was imatinib (Gleevec) for chronic myelogenous leukemia (CML) in 2001.

What is the Cancer Genome Atlas Project and what is TARGET?
The Cancer Genome Atlas Project (TCGA) compares cancer and normal genes within one patient against hundreds of cancers to learn what drives cancers. TARGET is similar to TCGA, with an additional focus on finding new targets for treatment of childhood cancers.

What has been learned from TCGA and TARGET?
In every cancer type studied, potential new targets for treatments have been found. TCGA will drive lab investigations and serve as a cancer database for researchers worldwide.

What are some of the challenges in translating cancer genomics findings into viable treatment strategies?
Some cancers with the same mutations respond differently to the same treatments. For example, BRAF drugs work in melanoma but not colon cancer. Beyond genes, cell signaling pathways play an important role in how a cell grows, survives and dies. We need to better understand the role of mutations within pathways and how that might differ between cancers.

How do researchers manage and share large amounts of genomic data?
TCGA has a data portal for researchers worldwide to search and analyze data generated by TCGA.

TCGA and TARGET will be completed by next year. What are future priorities?
We have to validate the success of treatment with the drug against its target. The NCI-Match trial is attempting to do this. NCI-Match is an important step toward personalized cancer treatments for patients because it assesses mutations and cancer pathways. Click here to read more about the NCI-Match trial at Massey. 

What are some resources for learning more about cancer genomics and precision medicine?
We recommend talking to your doctor for information on the role of cancer genomics in the treatment of your cancer. Massey is leading the precision medicine efforts in Virginia, and you can read more about that here.

Written by: Liza Janssen

Posted on: December 16, 2015