As you may know, personalized medicine is therapy that is chosen rationally based on the unique characteristics of the patient or the disease – the alternative being one-size-fits-all medicine, or decision by trial-and-error. Indolent Lymphoma survivors are well acquainted with the latter, evidenced by: “We could try this, or that, or the other. It’s up to you.” (No Standard of Care)
Treatment decisions can be based on Clinical Variables (stage, symptoms, age, and so on), but also on Biological Variables. The latter is based on tests of tissue (blood / tumor) that reveal differences in the underlying disease – such as a mutation that exists in one tumor but not another.
Importantly, clinically meaningful biological variation can exist within the same diagnosis – explaining why the same treatment is not equally effective on all patients with the same type of lymphoma. The jargon for this in the literature is “disease heterogeneity.”
Two recent reports provide evidence for progress based on the identification of biomarkers that appear to predict outcomes for patients independent of clinical variables:
First: the CLL the study comparing CC vs. CF found NO difference between these protocols, but importantly it identified patients who should not do either treatment -based on a mutation in the tumor cell. http://bit.ly/b6PQmW
Second: A study confirmed that 80% with Classic Hodgkin lymphoma are cured, but that a high number of tumor-associated macrophages (in the tumor microenvironment) are strongly associated with those who are not cured. http://bit.ly/9SuqJn
When a biological characteristic is found to predict outcomes it’s called a biomarker.
In these instances, patients (with the cytogenetic marker for CLL, or immune signatures for HL) can be spared the unproductive and non-reversible toxicity of these protocols – instead, can try other therapies – either less or more aggressive, depending on the goal of therapy.
With biospecimen-based research, patient outcomes can be compared, not just against other protocols, but also against suspected biological variables – to first identify and then validate biomarkers of response – to the benefit of all patients.
Essential to the conduct of such research is the adoption of STANDARDS for the capture, storage, annotation, and testing of the tissue (blood / tumor) so that the results of such tests can be compared across different studies – to increase the confidence we can have the tests are truly reliable for decision making.
For much more detail, see Biospecimen Research Network http://biospecimens.cancer.gov/researchnetwork/
~ KarlS
President, Patients Against Lymphoma
lymphomation.org