Getting Personal About Personalized Cancer Medicine

I got into this business 25 years ago, when my husband was diagnosed with Hodgkin’s disease.  I was a newlywed, and at 22-years-old, I faced the prospect of being a widow.  The evening we learned the shocking news, I remember leaving the hospital to return home. I was numb with fear.  I went into our bedroom and picked up the T-shirt he had casually dropped on the bed before we left for what we believed would be a brief doctor’s visit.  I didn’t expect to be returning to our home alone. I pressed the shirt to my face and breathed in his scent and sobbed uncontrollably.

Desperate for information on his disease, I decided then to use my journalism degree to write about cancer in terms that the average person could understand, and I have done that at the Johns Hopkins Kimmel Cancer Center ever since. For me, as for many others, cancer is very personal.

Hodgkin’s disease was considered one of the so-called “good” cancers.  Even though, he was diagnosed at a late stage, his doctors remained hopeful that my husband could be cured.  Now, looking back, I wonder if he was an early beneficiary of targeted cancer therapy.  At the time of his diagnosis in the early 1980s, scientists like Bert Vogelstein, had just begun to unravel the genetic mystery of cancer. Treatment focused on drugs that indiscriminately killed rapidly dividing cells.  Today, as this issue of Promise & Progress describes, we know that cancers respond—or don’t respond—to treatment, not so much based on the organs or systems they attack but rather because of the specific genetic makeup of the cancer.  Some of those very early drugs, we have since learned, were actually targeted agents; we just didn’t understand the targets at the time.

Throughout nine months of chemotherapy, my husband’s hair never fell out.  He took that as a good sign.  He would smile at me and say, “That means the chemo is busy taking out cancer cells.”  Perhaps he was on the right track. Hair loss is the iconic signature of the cytotoxic drugs used to treat cancer. These drugs take a broad swipe, causing collateral damage to not only cancer cells, but hair cells, gut cells (the cause of nausea and vomiting), and other rapidly reproducing cells. Today’s newer, targeted therapies work specifically against cancer cells and leave normal cells untouched, causing few side effects.  I recall many of the other Hodgkin’s disease patients going through treatment at the same time as my husband.  Several of them were diagnosed at an earlier stage than my husband, but they were much sicker.  A few of them died.  What was different about my husband?  Today, we know it was likely the genetic makeup of his cancer. Something embedded in the genetic code of his cancer made it more susceptible to therapy.  So, even though he had more cancer than other patients, something we traditionally thought of as bad, he was going to do better than patients who had less cancer but whose cells where genetically programmed to be inherently more dangerous.

Even with “good” cancers like Hodgkin’s disease, that have wonderfully high cure rates of 80 percent or greater, we don’t yet have all of the answers.  It doesn’t seem like a good cancer to patients who fall on the wrong side of the statistics and find themselves among the 20 percent not cured.  Now, there is great hope for these and other patients, as the research in this issue of Promise & Progress describes.  Within the next few years, as part of standard practice at the Kimmel Cancer Center, every patient will have his or her cancer analyzed to reveal its unique genetic signature.  It will provide the genetic evidence that explains why two seemingly similar cancers respond very differently to treatment. By revealing each patient’s individual genetic code--what makes it tick, if you will--our scientists and clinicians will be able to get the right treatments to the right patients.  Most importantly, we can begin to understand and make progress against cancers that currently cannot be cured.

I always had hope.  How could I not, witnessing and writing about the brilliant accomplishments of our scientists and clinicians over last two decades. I knew the time would come when the science, technology, and the hard work of the most gifted minds in medicine would converge and lead to advances in cancer prevention, diagnosis, and treatment we could only imagine 20 years ago.  That time is now.