Illustrated by Christina Zhao

Dusting Off the Old: A Novel Cancer Treatment Method Utilizing Pre-existing Ingredients

By Smriti Narayanan | SQ Summer 2024

Saltman QuarterlyStudent
··7 min read

Evolution drives biological change and has been the force to bring along numerous organismic additions since the origin of life.

Thriving on evolution and growth, cancer is a disease which negatively impacts humans. Like all living organisms, cancer cells fight to survive in the body at all costs. Almost as though the disease has a mind of its own, cancer cells adapt based on their host environment and easily develop resistance to medications and treatment plans. Several factors including environmental carcinogens like (asbestos and radiation), inheritance, and combinations of both amount to innumerable possibilities of mutations, many of which often cause cancer. Additionally, cancer can manifest differently depending on the person and its location in the body. The main challenge in cancer treatment is identifying an approach that works universally and brings us closer to the seemingly unfathomable goal of “curing cancer.” Thus, we turn our attention to personalized medicine, an up-and-coming treatment approach.

What is Personalized Medicine in Regards to Treating Cancer?

For a disease as aggressive and adaptable as cancer, an equally adaptable yet accessible treatment approach is necessary. Personalized medicine is an individualized treatment plan that focuses on the intricacies of a patient’s specific condition. Fields in health sciences, such as nutrition and pharmacology, currently rely heavily on personalized medicine, given the importance of specificity to each patient. In oncology, researchers and doctors discovered that the constant evolution of cancer decreases the overall success of standard treatment methods like chemotherapy and radiation. Around the 1990s, a surge in genome sequencing and the discovery of certain oncogenes (promoters of tumor growth) opened numerous doors for molecular medicine. Genome sequencing is the laboratory technique that utilizes databases to identify the entire genetic makeup of an organism. In 2003, Dr. Francis Collins, former director of the National Human Genome Research Institute, announced a preliminary model of the human genome and proposed his idea to undertake a personalized medicine project to the U.S. Congress. Dr. Collins’s Human Genome Project built a foundational bridge by which researchers compiled a database of genomic information, the Cancer Genome Atlas Program (TGCA), which has obtained over 20,000 molecular samples for 33 different types of cancer as of today. Utilizing genome and proteome (proteins) mapping specific to the genome of the cancer cells in each patient finally allows researchers to track which drugs can counter certain conditions. This is a massive leap in cancer biology due to the need to counter irregularities in cancer cell DNA.

How Do Researchers Come Up With a Specific Treatment?

Genome and proteome mapping particular to each patient enable scientists to identify which drugs might work to counter-proliferation, the replication of cancer cells, in a specific organ. It also grants scientists the ability to account for previously developed drug resistance or negative reactions to specific medications.

We currently have the technology capable of mapping all of our genetic information, but where does the treatment process actually begin? Mapping a cancer cell genome isn’t as straightforward as it might seem. The complexity of the genetic code forces researchers to uncover each cell’s ability to mutate uniquely. Once they identify the regions of DNA that are mutated in distinct cells, they can begin to track down the proteins responsible for cell growth and division. Then, researchers must turn the proteins off through a specific drug or treatment method. For instance, in chronic myeloid leukemia (CML) patients, the BCR-ABL or Philadelphia chromosome is the unique genetic marker that causes an abnormality in blood cells. With this in mind, researchers can narrow down the cancer type, location, and severity. Researchers then turn to the databases in search of specific drugs to counter the rapid growth of cancer cells.

Interestingly, some drugs which aren’t necessarily produced for the treatment of cancer can still have antiproliferative properties. According to epidemiological and retrospective data tied to breast cancer treatments, metformin, the drug used to treat type 2 diabetes through decreasing glucose absorption levels, is identified to have those growth-inhibiting properties. Unfortunately, metformin was found to be unsuccessful as a breast cancer drug in clinical trials. However, utilizing pre-existing medications can significantly reduce the cost of drug development and reveal the undiscovered potential of shelved drugs.

Aside from medication, doctors can advise patients to continue standard treatments like chemotherapy, surgery, or radiation, in addition to incorporating new drugs into their original treatment plan. Despite the anticipated efficiency of the plan, the unpredictable nature of cancer raises the question of what might happen if the necessary medication for a patient does not exist. In such cases, researchers would explore drug development, and if successful, eventually transition to clinical trials.

(Illustration by Christina Zhao)

Does This Only Apply to One Form of Cancer?

Personalized medicine is being used to treat a wide range of conditions beyond cancer. Its integration into oncology offers hope for patients who have been unsuccessful with conventional treatments and are seeking alternatives. As per the data in The Cancer Genome Atlas Program, there are over 33 different types of cancers identifiable through genome mapping including various carcinomas, adenocarcinomas, and melanomas across different organs. The data from cancer samples are currently being used to treat most solid tumors, but more research on hematological malignancies such as leukemias and lymphomas is necessary. Presently, the sole hematological cancer included in The Cancer Genome Atlas is acute myeloid leukemia, with only 200 cases characterized through sequencing. According to the Leukemia and Lymphoma Society, blood cancers accounted for nearly 9.4% of the estimated 1,958,310 new cancer cases in 2023. The evident lack of available information on blood cancers is due to difficulty in identifying successful research methods. Substantial research into mapping blood cancer cell genomes is essential to address the significant proportion of patients diagnosed each year.

Why is this important and can we continue to use pre-existing treatments such as chemotherapy, surgery, or radiation?

At present, chemotherapy, surgery, and radiation may be used in combination or individually on a case-to-case basis. While these remain the standard treatments for most cancer types, there are a few concerns to consider. Not all tumors are operable so depending on the grade and stage of the cancer, invasive procedures might not always be the safest option. The lengthy recovery process could negatively impact the overall immune response of the patient. Additionally, if the tumor has metastasized significantly, it may be unresectable, and surgery could potentially harm the surrounding tissues. Metastasis is the growth of tumor cells beyond the location of origin into adjacent tissue. As for radiation and chemotherapy, though mostly non-invasive, depending on the aggressiveness required to fight tumor growth, these treatments can be mentally and physically grueling for patients. Based on a study conducted by researchers at Jawaharlal Institute of Postgraduate Medical Education in 2023, 97.4% of patients in the study experienced at least one side effect from chemotherapy including fatigue (87%), loss of appetite (71.4%), chemo-intent, BMI, and several other factors regardless of their age. Along with the pain caused by the tumor, chemotherapy itself can have long-lasting detrimental effects on the body and mind. Luckily, thanks to genomics and personalized medicine, it is now possible to couple more effective drugs and tailor treatments to each patient’s unique needs. Preserving the quality of life for patients should remain a priority throughout the lengthy process of fighting cancer.

What progress can be made? Where are we today?

Curating a treatment plan tailored to the specific needs of each patient is ideal, but it faces challenges related to accessibility and efficiency. Sequencing each patient’s cancer cells can take from weeks to months, and sometimes even longer due to challenges such as cost. The cost of these cancer-specific sequences and medications is often far beyond what the average American can afford without insurance. The price is also beyond the reach in countries where cancer treatment advancements are slowly being introduced. That being said, there are currently over 2.5 petabytes of information in the Cancer Genome Atlas, and this amount is expected to increase exponentially due to the infinite possibilities of mutation and the unpredictable environmental effects stemming from climate change. The avenues for improving cancer treatment are endless, and ongoing research continually pushes the boundaries of what once seemed unattainable. Personalized medicine is emerging as a beacon of hope for the cancer pandemic, as it shows the immense bounds to be crossed in genomics and pharmaceuticals, with the ultimate goal of preserving the quality of life for cancer patients.

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