Last Resort Results in De Facto Cure
For Casey Carleton, 32, of Bartelsville, Okla., four traditional treatments, including chemo, radiation and surgery, had failed to stop the progression of his melanoma, which had spread from his skin to his lungs in 2008. He was given a 35 percent chance of living to see 2010.
As a "last resort," Carleton signed up for the MD Anderson trial in January 2010, where his cancer was treated not specifically as melanoma but as a "B-Raf" mutation cancer. He received an experimental drug that might also be taken by other B-Raf patients with colon cancer or parathyroid cancer. Unlike the harrowing chemo and surgery he had undergone in the past two years, his tailored treatment consisted of two pills, three times a day. Within two weeks, the remaining tumor in his lung had shrunk by 50 percent. At 16 weeks, he was officially in remission.
"It was such a relief. I didn't know if I was going to see my youngest son's first birthday, and now he's three. I get to keep going, coach softball, be with my kids," Carleton says. "For me, so far, this is a cure for my melanoma."
Carelton's wife Mary Ann is a little more cautious about the outcome: "Every nine weeks he goes in for scans to make sure it's still working. We call it 'scanziety' whenever those trips come up. For now, we live our lives nine weeks at a time and hope that he's one of the lucky ones that are cured for life."
The MD Anderson trial is part of a general movement toward personalized, genetically based cancer treatment. Over the course of the past few years, a number of studies have investigated the advantages of treating cancer according to genes instead of according to site.
In 2009, Massachusetts General Hospital began one of the most ambitious programs in personalized medicine when they sought to map the genetic fingerprint of the tumors of nearly all new cancer patients. They tracked 110 genetic abnormalities on the 13 major cancer genes, and used this information to tailor-make treatment cocktails, ideally avoiding the expensive, side effect-laden hit-or-miss approach that had been the standard of cancer care for decades.
The MD Anderson program takes this approach a step further by testing new genetically targeted drug therapies in a clinical trial environment. Though the results so far are more "proof of principle rather than proof itself," says Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, the findings are nonetheless promising.
This is "the future" of cancer care, says Dr. Stefan Gluck, clinical director of the Braman Family Breast Cancer Institute at the University of Miami.
The trials' positive results come with several caveats, however. Not every cancerous tumor has an identifiable mutation that would make such a targeted approach possible. Within the trial published today, of the 852 patients enrolled, only 354 had one or more actionable gene mutations.