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A remarkable revolution is rapidly transforming our entire clinical approach to breast cancer as well as other malignancies. This revolution is based on three new technologies—gene arrays, proteomics and information technologies—which together will have a profound effect on our management of breast cancer over the coming years. Amongst the most important questions that patients and their families want answers to are: 1. What is the prognosis of my tumor? 2. What is the best management regimen for my particular tumor? Generally the answers to these questions have been based on empiric clinical experience and analysis of a handful offactors, painstakingly gathered one at a time such asestrogen receptor status or the expression of theHER2/neuoncogene on the surface of the breast cancer. With the completion of the human genome project the identity of virtually all of the expressed genes in human tissues has been accomplished. It is now possible to analyze a tumor simultaneously for all of the genes expressed by the tumor cells (gene products are messenger RNA molecules which are 'translated' into proteins.) Amazingly, ALL of the different RNA molecules that could theoretically be made by a human cell are 'spotted' at different locations on a single slide. Then a sample of the patient's tumor is used to |
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interrogate each of these separate spots and a quantified signal is produced for each of these 30,000 spots. These expression patterns can be analyzed NOT based on a single gene or two but rather on the PATTERN of expression of all the RNAmolecules. These patterns have already been shown to be amazingly predictive for prognosis. In fact, these patterns are much better at predicting outcomes than any single analysis done in the past and are far more accurate than the 'gold standard' axillary: lymph node status. Several very large studies are already underway to validate this approach and it is not unreasonable to expect these methods to be in common clinical usage in the next three years. Similarly, the ability to directly analyze the majority of proteins expressed by a tumor (as compared with a single analysis of a singleprotein such as estrogen receptor) is rapidly progressing and this conceptually very similar approach will also be ready for clinical use shortly. Finally, both of these methodologies are being evaluated for their positive predictive value in ascertaining best therapies.It is virtually certain that most of the responsivity of human breast cancers to a variety of drugs is dependent upon theproperties of the tumor itself and by analysis of all of these properties simultaneously (e.g. the proteins or expressed genes) it is highly likely that far more accurate use of systemictherapy will be possible. |
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| Marc Lippman, MD has been appointed as the new Science Advisor for Expedition Inspiration. Julie Gralow, MD, Chair, EI Medical Advisory Board, made the announcement in March of this year. Dr. Lippman is currently the John G. Searle Professor and Chair, Department of Internal Medicine, University of Michigan Health System in Ann Arbor. Lippman will be taking over the duties as Science Advisor from Samuel Hellman, MD, who has led the Medical Symposium since its inception in 1995. Thank you Dr. Hellman. | |||
| UPDATE is published two times a year by EXPEDITION INSPIRATION 640 North Main . Box 4289 . Ketchum, Idaho 83340 . Tel 208 726-6456 . Fax 208 725-2091 . E Mail ei@expeditioninspiration.org | |||
