Matching Cancers With the Best Chemical Treatments

Roland Piquepaille writes "When oncologists meet a new patient affected by a cancer, they have to take decisions about the best possible treatment. Now, U.S. researchers have devised an algorithm which matches tumor profiles to best treatments. They've used a panel of 60 diverse human cancer cell lines from the National Cancer Institute — called NCI-60 — to develop their "coexpression extrapolation (COXEN) system." As said one researcher, "we believe we have found an effective way to personalize cancer therapy." Preliminary results have been encouraging and clinical trials are now planned."

Comments

Insurance

[ChromeAeonium]

Lets just hope that doctors who use this algorithm still throughly examine every patient before beginning treatment, because, while probably useful, I doubt its as effective as a full examination by a professional. I kinda wonder if this would be used in lesser insurance policies to substitute extensive examinations. Premium insurance plan gets a full examination prior to treatment, the plans that cost less have the cancer run through an equation, and a treatment is printed out.

Re:Insurance

[Daniel Dvorkin]

The application of the algorithm will come well after the "full examination by a professional" stage -- they'll be using it once the cancer has been diagnosed, and they're deciding on which of several specific treatments to use.

Re:Insurance

[piojo]

Lets just hope that doctors who use this algorithm still throughly examine every patient before beginning treatment, because, while probably useful, I doubt its as effective as a full examination by a professional. Actually, if I remember correctly, an algorithm is better than doctors at diagnosing heart attacks... something about doctors being too human, and being unable to ignore statistically unimportant factors such as age (that is, being younger makes you less likely to experience a heart attack in just the same way that being younger makes you less likely to experience the symptoms of a heart attack--a given set of symptoms is equally to indicate a heart attack, regardless of age). My source? Blink, by Malcolm Gladwell. I'm probably misremembering a some of the details, but the point is there.

You may be right about its effectiveness in some cases, but its correctness, once it's perfected, will most likely be statistically better than the judgement of doctors.

Re:Insurance

[_14k4]

My wife is a breast cancer survivor (people are survivors from day one) and we are in the process of finding out that, hopefully, it has not spread to her bones. I can tell you, with 100% certainty, that cancer patients and caregivers do not care what the insurance companies say. The doctor can bill me personally and take the money right out of my paycheck if you need to. I will also say that, in my own experience, the oncology centers we have used have cared less about insurance than my PCP! One of the first things they ask is, "Do you need money to help pay bills during all of this?"

I would hope that this is used in conjunction with other treatment options - not as a "failsafe to lower level insurances"...

Doctors generally won't like this

[syousef]

Most doctors won't even use computers to help them make diagnoses because they feel they should always be able to do better. What tends to happen is that if a rare condition presents they can miss it quite easily. I'm no doctor but I believe it has to do with the medical profession's heritage, culture and the politics of their licensing institutions. Doctors are taught that every diagnosis can be life or death. Using an aid like a computer to make the decision therefore is seen as a sign of weakness.

When you think about it that's insane. There's no way any doctor can know every medical condition that presents, even the rarer ones. What's needed is a system whereby the doctor can check his diagnosis against what comes up with a computer search against the same symptoms. There needs to be no stigma in doing this. If something comes up that's rare but could fit the doctor then needs to have a think about whether it's worth addressing. Systems like this have been rejected by the medical profession time and again which is unfortunate because to get good at diagnosis they'd need to be honed with a lot of feedback, particularly where multiple conditions present. However they have the potential to help pick up serious conditions earlier than what even the best doctor might without them.

Same goes for this system except we're talking treatment choice not diagnosis. One hurdle is getting other doctors to accept it. Another is making sure the control and final say remains with the doctor and patient not some machine. There'd be great temptation for the medical insurers to use such a system to avoid providing treatment that a doctor believes is necessary.

Re:Doctors generally won't like this

[macklin01]

Don't forget that the gap needs to be bridged from both sides: while it will indeed take some cultural changes in the medical community to use computational / predictive tools in choosing therapy, it will also require cultural changes in the modeling community to facilitate this. Furthermore, doctors' trust in computational tools must be earned by a well-validated track record of results by the mathematical / engineering community. Interestingly, these cultural changes are underway and can already be observed.

My primary field of research is developing computational tools for modeling cancer progression and angiogenesis, primarily using a PDE point of view where I model nutrient transport within the body and uptake by tumor cells, some simple biomechanics, the degradation and remodeling of the extracellular matrix by the tumor, and the resulting motion of the tumor boundary within the tumor. In fact, this was my dissertation topic just a little over a month ago; the interested reader can see my publications here and some animations of cancer simulations here.

In the several years I've been doing this work, I've seen interesting changes on both sides of the aisle. The mathematical models of cancer have grown in sophistication and realism at an incredible speed. Five or six years ago, models would only examine a single, isolated aspect of cancer growing in homogeneous tissues that were more idealized than even simulated in vitro petri dishes; today, they model many aspects of cancer and the interaction between those aspects. Several years ago, the models were little more than interesting mathematical objects with simplified, spherical solutions that weren't very interesting outside the mathematical community; today, we're simulating complex tumor shapes in fairly realistic tissues, and the results are shedding light on current problems in cancer biology that are otherwise difficult to understand.

Several years ago, it was difficult to even get doctors, oncologists, and others to even look at our research (in our field in general). Today, we're building a track record of results that makes the work easier to trust. Mathematicians and engineers are also realizing the need to acquire the "vocabulary" and biological background necessary to communicate with doctors and biologists, and they're making moves to bridge the gap and collaborate. In the meantime, more cancer biologists are realizing that it takes more than studying isolated cells to understand cancer systems, and they're reaching out to mathematicians to model these complex systems.

The result: very rich and exciting collaborations between doctors and mathematicians to develop helpful predictive tools. My group (at the UT Health Science Center in Houston, with the M.D. Anderson Cancer Center) is doing exciting joint work with oncologists, biologists, mathematicians, and engineers to combine experiments with well-calibrated models of glioblastoma, an aggressive form of brain cancer. Sandy Anderson and Vito Quarnata are doing similar joint mathematical/biological work on breast cancer at Vanderbilt and the University of Dundee, and their work has been featured on slashdot before.

So, it really requires growth toward collaboration from both sides, but fortunately, the need for this has been recognized by both communities and is occurring as we speak. It's a very exciting time in cancer systems biology and computational / predictive oncology! -- Paul

Re:Doctors generally won't like this

[bwen]

As a physician, I resent your inaccurate and uninformed response. "Doctors are taught that every diagnosis can be life or death" - where did you hear that? You are making sweeping generalizations and accusations. The ASSUMPTION that physicians resist using a computer to research a medical problem is ridiculous (at least in the US.) I do not know a MD that is not comfortable with a computer nor with researching a medical problem online. We often have resources that the general public does not use, and due to lack of an additional 7-11 years of post-grad training, would not understand. You seem to typify the person that turns to herbs from China that mostly consist of grass/dirt and expound how modern science is ignoring it. We very much appreciated you in the dark ages, thanks for your insight!

Not a new idea

[Crashbull]

There is a lab in Germany that's been doing that for years now. This isn't a new idea. I'm just really surprised and a bit disappointed that no one in the US has bothered to do something like this before.

Algorithm kindly sponsored by Pfizer

[Anonymous Coward]

int drug_choice_algorithm(){
   int our_most_expensive_drug = 1;
   int other_cheaper_option = 0;

   if(patient_has_insurance()){
       return our_most_expensive_drug;
   }
   else {
       if (patient_is_rich()){
           return our_most_expensive_drug;
       }
   }
   return our_most_expensive_drug;
}

 

Good news

[wamerocity]

I work at the Huntsman Cancer Hospital, a division of the University of Utah hospital. I draw blood on dozens of patients every day and see the same pattern of treatment as we see similar cancer patients come in. I can only see this as a good thing to help diversify and specialize treatments.

As someone who won the lottery and was treated in a cancer hospital myself, I found my doctor seemed to put me on a fast track to treatment, straight out of the books, which involved removing an important part of my anatomy (not THAT part). With much resistance on my part, I got him to investigate other options and I actually got to keep my spleen.

From a doctors POV, I know it can be difficult as well as uneconomical to see every patient as a super-special-individual-with-their-own-needs-and- feelings, but with the type of stigma surrounding the C-word (not THAT C-word) it is pretty much a necessity, at least from my experience. If this new system requires doctors to spend a little more time with a patient and yield a higher success rate, then it is an all-around win.