COMMENTARY

Finding Multiple Mutations in Cancer: Science vs the Media

April 02, 2012

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Hello, I'm Dr. Maurie Markman from Cancer Treatment Centers for America. I wanted to briefly discuss a very interesting paper that appeared in the March 8, 2012, issue of the New England Journal of Medicine.[1] The paper, "Intratumor Heterogeneity and Branched Evolution Revealed by Multiregion Sequencing," demonstrated rather impressively and convincingly the tremendous heterogeneity that is present even within an individual mass lesion in a patient with cancer. The paper demonstrated what I think many individuals expected it to demonstrate, which is that within an individual cancer -- and even an individual mass in that cancer -- one can see multiple patterns, mutations, and pathways that are arranged in an abnormal manner. Of course, we must be concerned about the impact of this heterogeneity on outcome.

These data do not indicate that it will be impossible to find mutations or pathways that are abnormal (so-called "driver mutations") and that, by being able to target the particular mutation that is most relevant in that cancer, there will be a very positive impact on outcome. It may very well be that there can be a positive impact on the driver mutation, but another mutation may become relevant in that tumor, and the drug or the strategies being used may have to be changed. This is clearly the future of cancer and its care. This is very complicated, but there is nothing in this report that suggests that we will not be able to find important patterns in individual tumors that will lead to effective therapies for controlling the tumor at least for some period of time, with the need to potentially change therapy when resistance is documented.

Another point about this paper that is relevant to note is that oversimplification has occurred in the media regarding this report. One prominent commentary discussing this paper was called "Personalized Medicine Hits a Bump." It is of concern when the media not only hypes the information that is coming out regarding the molecular signatures that are relevant in cancer but also takes a single report and suggests that there are very serious problems with the concept of precision medicine, our ability to document to a far greater extent the molecular abnormalities in cancer. I think it is very important for the media to be aware of the complexities of these issues, to attempt as much as they can to explain to the public what this genomic medicine revolution is all about -- to not overstate the benefits but also to not suggest, based on one report, that personalized medicine does not have a very important future in cancer management.

Again, I encourage you to read this important paper in the New England Journal of Medicine and the multiple advances that are announced almost weekly, giving us better understanding about both the molecular biology of individual cancers and pointing to ways to substantially improve the effectiveness of our therapy for common as well as uncommon tumors. Thank you for your attention.

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