Cancer Center designing patient-specific treatments

Tuesday , March 18, 2014 - 11:16 AM

Jennifer Garza

SACRAMENTO, Calif. -- The scan, Dr. David Gandara said, looked really good. Romeo Topacio nodded. He has stage four lung cancer -- the deadliest of cancers -- and for a moment he sat quietly, taking in the doctor's words.

Gandara continued, saying the tumor was responding to the targeted treatment. He held a paper with more test results, showing that Topacio's cancer is likely to be responsive to another drug as well.

"In case we need it in the future," said Gandara, a Sacramento, Calif., lung cancer specialist.

Gandara is confident his patient's tumor will respond to another drug because he has the molecular fingerprints and the mice to prove it.

The oncologist is providing specialized treatment at the University of California-Davis Cancer Center, which is at the forefront of what many consider the future of cancer care, with treatment designed specifically for each patient. It is the lead institution in a pioneering program that works with genetically designed mice to test drugs individually for each patient.

The pilot program, which started in 2009, combines research and treatment. Tissue is taken from the patient's tumor, and the "molecular fingerprint" is identified to determine specific care.

"Think of it this way: Everybody has a fingerprint, and they're all different," said Gandara, special advisor for experimental therapies at the cancer center. "The same is true for cancer, everybody's molecular fingerprint is different and that's been a big problem in treatment."

Topacio, 64, was diagnosed with lung cancer in February 2009. In the years since, the Roseville, Calif., resident has endured various medications and treatments. His cancer at one point went into remission, but came back. He has been seeing Gandara for the past several months.

The news that his cancer is responding to treatment is the best he has had in months, Topacio said. "I feel so relieved knowing that there's another drug that works, too."

Finding what works has been one of the challenges facing cancer doctors and researchers in the so-called "War on Cancer." A drug that works for one person may be ineffective or trigger severe side effects in another. Doctors and patients may try several different drugs -- costing time, money and sometimes lives -- before finding one that treats the cancer.

The goal of the collaboration between UC Davis Cancer Center, Jackson Laboratory West and the National Cancer Institute for Advanced Preclinical Research (CAPR) is to diagnose and target treatment quickly.

"This is a unique opportunity that we have that nobody else has," Gandara said. The doctor, a prostate cancer survivor, says this work could affect hundreds of thousands of cancer patients. "Maybe the way cancer will be cured in the future will come one patient at a time," he said.

More than 4,000 mice are growing more than 200 different tumors, with various types of cancers, and are housed at the Sacramento campus of the Jackson Laboratory, said Neal Goodwin, laboratory program director. The genetically designed mice were developed to ideally grow human cancer tissue, he said.

"This mouse is so unique it can grow human blood cells that no other mouse can," said Goodwin. Different drugs can be tried on different mice. "The patient can have new combinations of drugs tried on his tumor to see what works and he can be out golfing."

This "tumor library," said Goodwin, started small. "It started as a grass-roots project with us and UC Davis," Goodwin said. "And now it has taken off." Thirteen medical institutions across the country have joined the project, which was featured on the PBS "Newshour" last month.

Since the show aired, the cancer center has heard from patients across the country. Results to date are promising -- but not every cancer patient is a candidate, Gandara said.

"We don't want to give false expectations," he said. Numerous factors must be weighed. The tumor must be able to be biopsied, for example. Some tumors will not grow in the mice.

Jane Coyne, of San Raphael, Calif., was diagnosed with stage four lung cancer in 2010. She was told it was inoperable and incurable. She asked her doctor how many lung cancer survivors he had treated. None.

"I knew I needed another doctor," said Coyne, 59.

Two days later, she was at UC Davis Cancer Center. Gandara gave her the same diagnosis. "But then he said, 'I can manage you,' " said Coyne.

Doctors took a biopsy, analyzed Coyne's molecular fingerprint and began treatment. "With the molecular testing, they are not guessing," said Coyne. "They know ahead of time how you are going to respond to it."

It has not been easy. Coyne had radiation in December and said she is still recovering from side effects. But overall she has felt well. Three months ago, she and her husband traveled to China.

As for Topacio, he and Linda, his wife of 38 years, are also planning a vacation. The two will travel soon to Israel and the Holy Land. Topacio said this is part of the advice he received from Dr. Gandara.

"He told me to go on living my life," Topacio said.

His wife, seated beside him during his doctor appointment, chimed in: "And that's what we plan to do."


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