Not Responding to the Standard Cancer Treatment? Maybe You’re an Outlier

In a recent reply to a blog comment, I mentioned the term “outlier” to describe a woman with breast cancer who had an excellent response to bevacizumab-based therapy. This was part of a discussion about the drug and its role in cancer treatment. The term outlier was utilized to describe this woman’s excellent response to a drug combination that has not achieved statistically significant survival advantage in the general population of breast cancer patients.

While outliers may connote strangeness or removal from the norm, in contemporary cancer therapies being removed from the norm can be a very, very good thing. After all, a minority of cancer patients benefit durably from chemotherapy. Those patients fortunate enough to have long-term responses are the happy outliers who populate the scientific community’s grab bag of anecdotes.

However, to the individual patient, a good response is much more than an anecdote, it is a life saving experience, an experience that every cancer patient richly deserves. While clinical trials are designed to identify average improvements for average patients, virtually every trial conducted has patients who live much longer than average. They constitute the tail on the survival curve and almost every trial has several.

Our job should be to identify those true responders and treat them appropriately rather than denying them active treatments based on the failure of the average patient paradigm. In statistics, the term applied for these failures are “beta errors,” meaning that the investigators missed the benefit of a given treatment. By identifying active treatments in small subsets of patients, functional analytic tools (like the Rational Therapeutics EVA-PCD platform) enable us to select those small subsets for treatment regardless of average expectations.

About Dr. Robert A. Nagourney
Dr. Nagourney received his undergraduate degree in chemistry from Boston University and his doctor of medicine at McGill University in Montreal, where he was a University Scholar. After a residency in internal medicine at the University of California, Irvine, he went on to complete fellowship training in medical oncology at Georgetown University, as well as in hematology at the Scripps Institute in La Jolla. During his fellowship at Georgetown University, Dr. Nagourney confronted aggressive malignancies for which the standard therapies remained mostly ineffective. No matter what he did, all of his patients died. While he found this “standard of care” to be unacceptable, it inspired him to return to the laboratory where he eventually developed “personalized cancer therapy.” In 1986, Dr. Nagourney, along with colleague Larry Weisenthal, MD, PhD, received a Phase I grant from a federally funded program and launched Oncotech, Inc. They began conducting experiments to prove that human tumors resistant to chemotherapeutics could be re-sensitized by pre-incubation with calcium channel blockers, glutathione depletors and protein kinase C inhibitors. The original research was a success. Oncotech grew with financial backing from investors who ultimately changed the direction of the company’s research. The changes proved untenable to Dr. Nagourney and in 1991, he left the company he co-founded. He then returned to the laboratory, and developed the Ex-vivo Analysis - Programmed Cell Death ® (EVA-PCD) test to identify the treatments that would induce programmed cell death, or “apoptosis.” He soon took a position as Director of Experimental Therapeutics at the Cancer Institute of Long Beach Memorial Medical Center. His primary research project during this time was chronic lymphocytic leukemia. He remained in this position until the basic research program funding was cut, at which time he founded Rational Therapeutics in 1995. It is here where the EVA-PCD test is used to identity the drug, combinations of drugs or targeted therapies that will kill a patient's tumor - thus providing patients with truly personalized cancer treatment plans. With the desire to change how cancer care is delivered, he became Medical Director of the Todd Cancer Institute at Long Beach Memorial in 2003. In 2008, he returned to Rational Therapeutics full time to rededicate his time and expertise to expand the research opportunities available through the laboratory. He is a frequently invited lecturer for numerous professional organizations and universities, and has served as a reviewer and on the editorial boards of several journals including Clinical Cancer Research, British Journal of Cancer, Gynecologic Oncology, Cancer Research and the Journal of Medicinal Food.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: