Advances over the last 10 to 15 years in DNA sequencing technologies revolutionized our understanding of cancer as a disease resulting from deleterious alterations to DNA. By identifying cancer driving genes, this work fueled research in targeted treatment and prevention strategies. There are still many challenges, however as we see promising targeted therapies fail in clinical trials or patients recur after initial response.
Being able to identify patients most likely respond to these new therapies, and those who have stopped responding, will be critical to the success of targeted therapies and breast cancer treatment overall.
A blood test known as a “liquid biopsy" is being tested in clinical trials led by BCRF investigators to identify markers in blood that can then be used to select the right patients for the right drug in future trials. Dr. Ben Park explained that while liquid biopsy is a highly promising technology that may one day allow for non-invasive monitoring of disease, early detection and prognosis, it still needs to be rigorously tested in clinical trials to ensure that the information obtained by liquid biopsy is reliable. “Liquid biopsy tests are not yet ready for prime time, ”he cautioned.
Another exciting new technology is CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats, pronounced “Crisper”). CRISPR is a gene editing technique that allows scientists to easily replace or delete specific sections of DNA. The technology is used in the lab to identify pathogenic (disease causing) mutations and to create laboratory models of disease by manipulating specific genes. CRISPR has accelerated many laboratory studies that would otherwise take months or years to complete. Asked whether CRISPR could have any clinical applications, Dr. Nikhil Wagle explained that the technology is in its very early days and it’s too soon to assess its therapeutic or diagnostic utility in patients.
One of the consequences of the rapidly advancing “omics” technologies (the characterization of a complete profile of a particular class of biologic molecules) is the amassing of huge collections of data on DNA, RNA (genomics, epigenomics, transcriptomics), protein (proteomics, metabolomics) and other molecules from patients with cancer. The challenge of “Big Data”, as it’s come to be known, is knowing how to use it to benefit patient outcomes, e.g. being able to filter out the “noise” to identify what information is clinically meaningful.
Dr. Peter Kuhn explained that deciphering big data requires a new interdisciplinary approach. Clinicians and laboratory scientists are collaborating with mathematical and engineering scientists in unprecedented ways to devise new approaches to study the data siloed in the large clinical and research databases. Dr. Funmi Olopade added that another piece of the big data pie will be the human and cancer microbiomes- the complete microbacteria profile (microbiomics) in the human body.
Information obtained from these collaborations promises to accelerate drug discovery, predictive and prognostic biomarkers, as well as preventive strategies for high-risk individuals.
BCRF recently launched a new Mathematical Oncology Initiative to tackle some of the challenges of big data. You can read more about the initiative here.