Cancer Medicine – A Humbling Experience

In his brilliant 1998 book, Consilience, Edward O. Wilson, notes: “The cost of scientific advance is the humbling recognition that reality was not constructed to be easily grasped by the human mind.”

This sententious point has remained a guiding principle in my thinking about human cancer. It is critically important for scientific investigators to be humble. We are explorers in a field more complex than any man-made system. We must be instructed by biology – as biological events will always find a way to outsmart our best efforts to explain them.

I was reminded of E.O. Wilson, when a colleague forwarded a recent publication from Molecular Cancer Therapy, “Molecular Profiling of Patient with Colorectal Cancer and Matched Targeted Therapy in Phase I Clinical Trials,” Dienstmann, R. et al MOL CANCER THER Sept 2012. The study conducted by the Molecular Therapeutics Research Unit at Vall d’Hebron Institute of Oncology in Barcelona, Spain, evaluated 254 patients for evidence of specific genetic aberrations. Their genomic analyses included, KRAS, BRAF, PIK3CA, PTEN, and pMET. Patients were then provided clinical therapy trials that matched the targeted agents (drugs with activity against the specific mutation) with their individual mutation profiles

In all, 68 patients received treatment constituting a total of 82 different molecularly targeted therapies. The clinical response rate for this population of patients who received molecularly selected therapy was 1.2%. No that isn’t a typo; it was really one point two percent.

While I applaud the scientific concept of this trial and must admit that I might have expected a somewhat higher response rate, I am not surprised by the result. In keeping with E. O. Wilson’s quote, human biology is not a puzzle designed to be solved by humans; it is instead the complex product of a billion years of evolution. Rather than demanding that cancer patients respond to those treatments we have selected for them based on genetic information, we should be instructed by the tumor’s behavior of each patient and use those insights to select amongst active drugs, whatever genetic elements they may have been originally designed to target. In my lectures, I describe this approach as the wisdom of whole cell experimental models.

I am continually humbled by the complexity of human tumor biology and delighted to have the insights that my patient’s cancer cells provide through the functional profile created by our EVA-PCD assay. Not only do I gain exciting scientific knowledge, but my patients have very good responses to the drugs we select. Not a bad day’s work.

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.

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