This morning I posted some exciting research from France that reports on a gene expression signature that predicts whether someone with colorectal cancer will respond to FOLFIRI treatment.
Instead of having to try the chemotherapy, wait several weeks, and run scans to see if the tumor is getting smaller, testing for fourteen genes in a patient’s tumor could tell doctors right away whether it was worthwhile to treat with FOLFIRI.
When I was first diagnosed with colon cancer nearly 25 years ago, there was one drug used to treat it — 5FU or fluorouracil. It had been around since the fifties, not very effective, but the only thing available. When a modifier drug — either levamisole or leucovorin — was added to it, it just about doubled expected survival time. But that still was only a year.
Today standard treatment still has the old standby 5FU as the backbone of treatment, but two new chemotherapy drugs are available along with three biologic agents and an oral form of 5FU. Median survival has doubled again, to two years.
The problem with these new choices is making the choice. What works best for what patient. Will the tumors shrink? Will patients have life-threatening side effects? What should we start with?
Like other cancers, colon and rectal cancer has entered a brand-new era of personalized medicine. Giving the right treatment to the right patient at the right time will save frustration and unnecessary misery. For some patients, it will save lives.
The French research team dug through more than 14,000 genes before they narrowed down their search to 14. This is painstaking, difficult laboratory work. It is made possible by better technology and bigger and faster computers. It would have been impossible twenty-five years ago. It would have been impossible even ten years ago.
But it is not only possible today — it’s happening. We may soon be able to decide the best treatment or whether someone needs chemotherapy at all.
This is expensive research and demands highly skilled scientists. Many experiments will lead nowhere and scientists will have to begin over and try again. We need to have the patience to support it and the willingness to pay for it.
Cuts in research funding for the National Cancer Institute demoralize these dedicated scientists and jeopardize their work. We have to fund the fight!
Colorectal cancer is preventable, treatable, and beatable.
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