No One is More Interested in Curing Your Cancer Than You

A diagnosis of cancer thrusts a, heretofore, healthy individual into the strange and unfamiliar territory of medical oncology. Many of my patients describe this transition as “entering the cancer bubble.” Suddenly, you are on the inside and everyone on the outside is talking at you about what to do, where to go, whom to see, and what treatments to receive.

From the inside of the bubble however, all of this has a hollow ring as you ponder many options, few good and some, positively frightening. Unfortunately, few patients have the time to complete a MD, or PhD, between diagnosis and the initiation of treatment. Lacking the requisite expertise, they turn to the “authorities” for advice.

Depending on which “authority” one consults, the recommendations may be colored by prejudices and biases. Some physicians adhere strictly to the National Comprehensive Cancer Network guidelines. Others insist upon accrual to Cooperative Group and Phase II trials. University-based investigators will often recommend developmental studies. And some physicians will follow the path of least resistance, examining such issues as cost, chair time and reimbursement, before considering what treatment to deliver.

It is in this milieu, that patients find themselves adrift. Who exactly should you trust? What is their motivation? To put it crassly, when they recommend a specific treatment, what’s in it for them: Cooperative Group points (provided to the most active accruers), academic accolades (the currency of junior faculty), cost containment (the purview of the managed care physicians), or finally, profit margins? Yes, there are a small number of physicians whose choices reflect their own pecuniary interests.

The antidote to all this uncertainty lies within each patient; answers to vexing questions crying out to be heard. These answers reflect the biologic features of each individual’s tumor. What pathway, what repair mechanism, what survival signal drives your tumor? No one has a perfect answer, not the genomic investigators (despite their protestations to the contrary), nor the immunohistochemists, despite the significant appeal of the platform. And not the immunologist (despite brilliant progress in this field over recent years). The closest approximation to human tumor biology is, well, human tumor biology. Using cellular constructs, in the form of native state microspheroids, we can today approximate the response profiles of patients undergoing systemic therapies. Using systems approaches to complex questions, the multitude of factors that contribute to objective response can be examined and elucidated.

No test is perfect. No patient is guaranteed a good outcome. Yet, doubling the objective response rate, and as we and others have documented, improving the time to progression and overall survival can be achieved with available methodologies that apply functional profiling to individual tumors.

No one would walk away from an investment formula that doubled the value of their portfolio. Few would turn down the opportunity to enhance their real estate positions predicated on reliable information from a realtor. Yet everyday, physicians convince patients to walk away from available, published, established methods that can improve response rates, diminish toxicities and avoid futile care. In this environment it is critical for patients to take charge of their own cancer management. Patients must not be dissuaded from seeking the best possible outcomes. Physicians, no matter how well intentioned, are human. Their opinions can be colored by misconceptions and an incomplete understanding of the questions at hand. Laboratory analysis empowers patients to make smart decisions.

In the game of cancer we need all the help we can get. After all, no one is more interested in saving your life than you.

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.

4 Responses to No One is More Interested in Curing Your Cancer Than You

  1. Sandra Knott says:

    Dr. Nagourney,

    Great topic, this is so true and sad that doctor’s in the field of Oncology do convince patients to walk away from trying this chemosensitivity testing. I have heard it time and time again, based on their opinions and misconceptions, instead of encouraging a patient who inquires about it saying it couldn’t hurt to do it and might help you. Or offer it to patients as an option of something to try.

    This is why patients need to take an active roll in their care and remember that is not the doctor’s life that hangs in the balance it is theirs. Even my own Oncologist who I dearly love and have a lot of respect for, when I inquired about your testing told me he didn’t think there was any validity to the testing. I had already had a consultation with you and was excited about having this as an option for me, so his response surprised me.
    I asked his some questions to see why he thought this. I asked if he had ever talked to you? Answer No. I asked if he had ever heard you speak anywhere? Answer No. He said he did not know you, but knew of you. I said that I had just had a consultation with you and I spent $500 1 1/2 hours with you and it was the best $500 I’ve ever spent. And if we can find a place to biopsy that is what I want to do, which we did in 2011. So now I have a Plan B if and when Plan A stops working.

    Patients need to learn that they need to ask questions of their Oncology team and if there is something they are interested in they need to research it and contact the person who has experience in do it. It can make the difference between life and death.

    Sandra

    • Every physician wants what is best for thier patients. Unfortunately, due to a series of misguided and failed attempts to use human tissue to predict cancer therapy response in past (clonogenic, H3*Thymidine-incorporation, etc) some physicians, even capable and sophisticated ones, have a blind spot when it comes to the newer work in this field. During their training, they were told that these tests did not work. In point of fact, during their training the available tests did not work. What we need to do now, is to educate these well-intentioned but not fully informed doctors that the field has evolved and with it the very compelling data to support its application.

      Thank you for our comment.

      • Sandra Knott says:

        Dr. Nagourney,
        I agree and believe me I do my best to do this with EVERY Physician I interact with. I always give them your website, in hopes that they will educate themselves on what you do.
        You are welcome, I very much appreciate what you do.
        Sandra : )

  2. Pingback: Dr. Robert Nagourney and Patients Describe “Cancer Bubble” « Rational Therapeutics – Hope Practiced Here for Cancer Patients

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