Topol on Notable Cancer, Prescription Drug, and Wearable Technology News

|Disclosures|January 28, 2014


Before I get into the happenings of 2014, I'd like to thank all of you for the terrific feedback we received on the interview I did with Atul Gawande that posted on the site in December. He's certainly one of the most intriguing people in the world of medicine. I plan to continue my mission for the One-on-One series: to bring you in-depth conversations with the practice of medicine's equivalents to "the most interesting [people] in the world" (think Dos Equis, if you watch enough TV).

New and Noteworthy in Cancer and Pharmacogenomics

The new year got off to a fast start, and I want to highlight a few noteworthy points of progress.

Let me start off with the provocative New York Times op-ed, "Why Everyone Seems to Have Cancer,"[1] written by George Johnson, who also recently published a book, The Cancer Chronicles. In the Times piece he points out that cancer deaths are actually not as frequent as deaths from heart disease. A graphic from the Times, which combines information from the Centers for Disease Control and Prevention and the National Vital Statistics System, demonstrates this point.

Johnson points out that somatic mutations march on as we get older, and even targeted drugs have not had a durable impact on these mutations because resistance to these drugs frequently emerges 9-12 months after an initial remarkable response.

The relatively flat curve for cancer deaths since data were first available in 1958 is indeed sobering. But Science highlighted -- as the "Breakthrough of the Year" -- the use of immunotherapy for cancer and the marked responses that drugs like PD-1 inhibitors are having in the clinic.[2] And an article published in Nature[3] on the delineation of cancer mutations across 21 tumor types continues to add momentum to cracking the biologic underpinnings of this disease. So I remain optimistic, what with all the tools we have, that someday the cancer curve will resemble the heart disease curve in the above graphic.

Also in genomics, I'd like to mention a major report on pharmacogenomics and the response to lithium for bipolar disorder.[4] A sequence variant fully predicted whether there would be a clinical response in a cohort of Han Chinese individuals, with replication and an odds ratio of 120! Very high odds ratios are not so unusual with drug response or major side effects, and I have included a table below that I put together to show the top odds ratios reported so far. Sadly, we are sitting in prescription medicine darkness, whence there are over 6000 medications and there are genomic data for less than 2% of them. Much more needs to be done for commonly prescribed meds and for those in clinical investigation.

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  1. Johnson G. Why everyone seems to have cancer. New York Times. January 4, 2014. Accessed January 21, 2014.

  2. Couzin-Frankel J. Cancer immunotherapy. Science. 2013;342:1432-1433. Abstract

  3. Lawrence MS, Stojanov P, Mermel CH, et al. Discovery and saturation analysis of cancer genes across 21 tumour types. Nature. 2014 Jan 5. [Epub ahead of print]

  4. Chen CH, Lee CS, Lee MT, et al. Variant GADL1 and response to lithium therapy in bipolar I disorder. N Engl J Med. 2014;370:119-128. Abstract

  5. Hafner K. A busy doctor's right hand, ever ready to type. New York Times. January 12, 2014. Accessed January 23, 2014.

  6. Peterson K. "Internet of things" all the rage at Consumer Electronics Show. CBS Moneywatch. January 7, 2014. Accessed January 23, 2014.

  7. Wasik B. Why wearable tech will be as big as the smartphone. WIRED. December 17, 2013. Accessed January 23, 2014.

Authors and Disclosures


Eric J. Topol, MD

Director, Scripps Translational Science Institute; Chief Academic Officer, Scripps Health; Professor of Genomics, The Scripps Research Institute, La Jolla, California; Editor-in-Chief, Medscape

Disclosure: Eric J. Topol, MD, has disclosed the following relevant financial relationships:
Serve[d] as a director, officer, partner, employee, advisor, consultant, or trustee for: AltheaDX; Biological Dynamics; Cypher Genomics [Co-founder]; Dexcom; Genapsys; Gilead Sciences, Inc.; Portola Pharmaceuticals; Quest Diagnostics; Sotera Wireless; Volcano
Received research grant from: National Institutes of Health; Qualcomm Foundation

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