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Docs May Be Overly Conservative in Use of New Drug Combinations for Cancer, UCSD Speaker Suggests; Over 4 Million Three-Drug Combinations of Existing Drugs Possible, Too Many for Clinical Trials; Biomarker Use to Target Treatment Is Recommended

(BY MICHAEL A. GOLDMAN, PhD, Professor, Former Chairman of Biology, San Francisco State University). Speaking at this week's 2018 annual meeting of the American Society for Human Genetics (ASHG) in San Diego (October 16-20), Razelle Kurzrock (photo),MD, Director of the UC San Diego (UCSD) Center for Personalized Cancer Therapy, told a very large audience that oncologists have been conservative about using new drug combination therapies. Yet, with nearly 300 drugs on the market, there are more than 4 million 3-drug combinations, far too many to test in controlled trials. She uses a patient-centric, rather than a drug-centric, treatment plan, employing a consistent strategy, but with different drugs or, when appropriate, immunotherapy. Addressing more than 600 scientists and clinicians in a two-day symposium sponsored by the Pharmacogenomics Research Network (PGRN), Dr. Kurzrock said cancers are like malignant snowflakes, each different and magnificently complex. Profiling more than 12,000 tumors using genomic markers, her group uses biomarkers to target treatment in a "tissue-agnostic" manner. For example, PIK3CA mutations are found in 10% of patients with advanced cancers, and can be seen in a subset of most cancer types. Elevated HER2 expression occurs across a wide variety of tumors, and the same HER2 antagonists seem to work. Dr. Kurzrock calls her approach PREDICT (Profile-Related Evidence Determining Individual Cancer Therapy), which reflects a family of master protocols at UCSD. These protocols for trial combinations of drugs have limited exclusion criteria; almost every patient in need is eligible. Dr. Kurzrock stressed the need for genomics education for medical professionals, which she finds to be inadequate today. "In five years," she says, "it will be routine practice to do these [genomic] tests."

[UCSD Center for Personalized Cancer Therapy] [ASHG Annual Meeting 2018]