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New Tumor Targeting Strategies

30 Jun

A new study mentioned in a recent New York Times article reveals that “the best strategy is to hit tumors with two or more targeted cancer therapies at once.”

The Promise of Precision Medicine

27 Jun

How expanding the use of genetic and other scientific data can help us better target and transform patient treatment and cures:

http://abclocal.go.com/kgo/story?section=news/health&id=9139914

I-Spy Trial Offers Key Insights Into Locally Advanced Breast Cancer

30 May

Dr. Laura Esserman, director of UCSF Helen Diller Family Comprehensive Cancer Center’s Breast Care Center is spearheading the development of a clinical trials model designed to accelerate and improve the efficiency with which experimental breast cancer therapies are assessed.  The strategy, which involves the use of molecular markers and MRI, utilizes “adaptive design,” in which drugs are assessed over the course of months – rather than decades – and the information used in real time to direct the course of a trial.

The series of studies are known as I-SPY (investigation of serial studies to predict therapeutic response with imaging and molecular analysis) and are being carried out  in patients with locally advanced i.e., aggressive – breast cancer. The goals of I-SPY  are to establish a clinical trials model that supports the identification of drugs targeting the molecular profiles of aggressive cancers, and to reduce the duration of the drug-assessment process from the current 15 to 20 years down to a few years.

Dr. Esserman’s team presents several findings at ASCO today.  One provocative finding shows that large, locally advanced forms of breast cancer often emerge between regular mammogram exams. These “interval” cancers present an important opportunity for doctors and patients to take advantage of neoadjuvant therapies in advance of surgery, with the hope they would be responsive. The other finding is that using molecular markers, UCSF researchers identified a subset of patients who do well regardless of how they respond to neoadjuvant treatment. They also identified a subset  with poor prognosis for whom response to neoadjuvant therapy is a good predictor of long term outcome.

Read the press release:
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Genetic Counseling for Breast and Ovarian Cancer Risk

5 Apr

BRCA1 and BRCA2 are genes that increase the risk of hereditary ovarian cancer, as well as hereditary breast cancer. Testing for mutations in the BRCA1 and BRCA2 genes can predict cancer risk, and can now possibly be used to guide treatment and entry into clinical trials.  Dr. Mary S. Beattie, Director of UCSF’s Cancer Risk Program, discusses who should have genetic counseling and why.

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links for 2009-02-24

24 Feb

New Theory About the Cause of Alzheimer’s Disease – a Prenatal Link?

22 Feb

pj-ao487_resear_g_20090218123227New research at Genentech provides a provocative theory about the cause of Alzheimer’s disease and   suggests potential new targets for therapies to treat it, reports Ron Winslow in the February 19 issue of the Wall Street Journal.

The prevailing view about what causes Alzheimer’s disease is that  deposits called beta amyloid accumulate in the brain, destroying nerve cells and ultimately, the patient’s memory.  Now, new research shows there’s a very different way of looking at the disease.

The Genentech/Salk Institute team of researchers propose that a normal process in which excess nerve cells and nerve fibers are pruned from the brain during prenatal development is somehow reactivated in the adult brain and “hijacked” to cause the death of such cells in Alzheimer’s patients, writes Winslow.

According to Marc Tessier-Lavigne, executive vice president, research drug discovery at Genentech, the new findings offer evidence that “Alzheimer’s is not just bad luck, but rather it is the activation of a pathway that is there for development purposes.”

Genentech has identified potential drug candidates based on the findings and says that it may take many years for any potential treatment to be developed.

The research was published Thursday in the journal Nature.

NOTE: The photos of normal and dead nerve fibers above are from Dr. Tessier-Lavigne.

links for 2009-02-17

17 Feb

Creating Designer Babies: Screening for Disease and Desirable Traits

15 Feb

Pre-implantation genetic diagnosis, or PGD, has been used to screen for genes that lead to diseases such as cystic fibrosis and cancer.  Now, the lab procedure that screens for diseases in embryos is being offered to create designer children. Two articles on the topic have appeared recently; they both address the medical and ethical implications.

Last month, the New Scientist reported that the first UK baby genetically selected to be free of a form of breast cancer caused by BRCA1 was born in London.  It was reported that the parents underwent IVF, and the resulting embryos were screened with PGD, where a small number of cells are removed and tested. Only embryos free of the BRCA1 gene were implanted. Five  embryos tested were found to be free of the gene and were implanted; one resulted in the pregnancy.

Gautam Naik reported in February 12 issue of The Wall Street Journal that LA- based Fertility Institutes, will soon help couples select both gender and physical traits in a baby when they undergo fertility treatment. Dr. Jeff Steinberg, director of the clinic, claims that trait selection “is a service” that he intends to offer soon.  According to Naik:

For trait selection, Steinberg is now betting on a new approach for screening embryos. It involves taking cells from an embryo at day five of its development, compared with typical PGD, which uses cells from day three. The method potentially allows more cells to be obtained, leading to a more reliable diagnosis of the embryo.

Many countries have banned the use of PGD for gender selection; it is permitted in the U.S. According to a 2006 survey by the Genetics and Public Policy Center at Johns Hopkins University,42% of 137 PGD clinics offered a gender-selection service.

Creating Designer Babies: the Smackdown Continues

15 Feb

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PGD, or pre-implantation genetic diagnosis is being used to screen embryos for diseases such as cancer, and it’s now  being used to pick traits like gender, eye and hair color.  Last month, the New Scientist reported that the first UK baby genetically selected to be free of a form of breast cancer caused by BRCA1 was born in London.  Gautam Naik reported in February 12 issue of The Wall Street Journal that LA- based Fertility Institutes, will soon help couples select both gender and physical traits in a baby when they undergo fertility treatment. Dr. Jeff Steinberg, director of the clinic, claims that trait selection “is a service” that he intends “to offer soon.”

Are we going too far? You decide.

DNA and Your Personal Health — Is Too Much Knowledge Good?

24 Jan

In the coming era of consumer genetics, your DNA will have much to tell you about the biological bases of your health, your physique and even your personality. But will this knowledge really amount to self-knowledge? asks Steven Pinker in his article My Genome, My Self, which appeared in the January 11, 2009 issue of the Sunday New York Times.

We've entered the age of personal genomics — where Pinker says "the plunging cost
of genome sequencing — will soon give people an unprecedented
opportunity to contemplate their own biological and even psychological
makeups".  For example, 23andMe provides
a genetic report card and directs customers to a web page which
displays risk factors for 14 diseases
and 10 traits. This page also provides links additional diseases and
traits which according to Pinker, have iffier scientific substantiation.

This latest "do it yourself genomics" trend coincides with the new promise of personalized medicine – where drugs are being tailored to an individual's genetic makeup.  The downside to this trend ranges from dubious companies which prey on hypochondriacs, to insurance and ethical isues.

For now, the jury is out on the benefits of personal genomics. I like Pinker's concluding thoughts:

So if you are bitten by scientific or personal curiosity and can think
in probabilities, by all means enjoy the fruits of personal genomics.
But if you want to know whether you are at risk for high cholesterol, have your cholesterol measured; if you want to know whether you are good at math, take a math test.

The Internet is accelerating biomedical progress in understanding and treating disease. Personally, I believe in the potential of services like 23andme — it empowers individuals to take control of their medical destinies and enables them to create virtual cohorts for clinical research and trials.  With tools like these, personalized medicine will evolve even faster.