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Precision medicine 101

OCTOBER 25, 2017
Clinical Congress Daily Highlights, Wednesday Second Edition

Precision medicine — the concept of tailoring treatment and therapies to individual patients — has become inescapable for physicians. A Wednesday session on the topic offered a brief introductory course for surgeons who are unfamiliar with the latest advances in the area.

“It really comes down to stepping out of your comfort zone,” said Timothy Yeatman, MD, FACS, Gibbs Cancer Center, Spartanburg, SC. In his opinion, personalized medicine will only continue to grow, making it incumbent upon surgeons to learn about the latest in DNA sequencing, RNA sequencing and new proteomic techniques.

The session touched on a number of emerging technologies, while also providing a survey of clinical tests that are influencing oncology. Raphael Bueno, MD, FACS, Harvard Medical School, Boston, MA, provided a comprehensive review of the latest RNA transcriptomic assays, including microarray analyses and RNAseq.

“Why bother to measure transcripts? Well, the RNA expression profile can give you some sort of a measure of the expression of a whole set of genes, and that can give you an idea of what that particular tissue, tumor, cell behaves like.”

This information could help physicians determine the course of treatment by matching a person’s specific transcriptomic signature with a suitable therapy. This approach has already become the standard of care in a number of different cancer types of cancer, including lung, breast and certain melanomas.

Beyond matching therapies to a person’s transcripts and genes, therapies are being tailored to a person’s immune signature. Immunotherapy has rapidly emerged in the past few years as a new treatment paradigm across a number of cancers.

“There are a number of different forms of immunotherapy that have been adopted in the clinic. But checkpoint blockade is truly the ‘hot’ area in immunotherapy,” said Elizabeth A. Mittendorf, MD, PhD, FACS, MD Anderson Cancer Center, Houston, TX.

Checkpoint inhibitors work by “removing the brakes” from T cells so they are better equipped to directly engage and kill cancerous cells. Numerous checkpoint inhibitor therapies have been approved in the last several years, but as Dr. Mittendorf explained, oncologists are still developing biomarkers to predict response in patients. This effort includes measuring certain protein expression levels, different types of immune cells, gene expression signatures and even using the microbiome to determine how a person might respond to certain checkpoint inhibitors.

Precision medicine and immunotherapy in particular are rapidly evolving; all three panelists agreed that it’s important for surgeons to remain knowledgeable about the latest advances.

“The field (of precision medicine) is moving very quickly, and if, in fact, asked to do this talk next year, I’m going to have to redo my slides,” Dr. Mittendorf said.

Additional Information:
The Panel Session, Precision Medicine in Surgical Oncology: What Every Surgeon Needs to Know, was held October 25, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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