More than 230,000 women will be diagnosed with breast cancer in the U.S. this year, a diagnosis that comes with treatment choices that can be overwhelming to patients and complex to their doctors. But what if there was only one treatment for your breast cancer? And what if it was based on your genetics and specific cancer type in the hope of maximizing its effectiveness?
That's the promise of personalized medicine, and research at the University of Pittsburgh Cancer Institute (UPCI) is bringing that promise closer to reality every day. Just eight months after UPMC announced a $100 million, five-year project to create a novel warehouse of clinical and other data, UPCI researchers said they had found intriguing differences between some breast cancer patients which eventually could provide a roadmap for developing these targeted, personalized therapies.
"Cancer is a driving area of personalized medicine. Not only is cancer on pace to soon surpass heart disease as the No. 1 killer of Americans, but it's an area where we give the same therapy to almost everyone - whether it works on them or not. With personalized medicine, we can do better," said Adrian V. Lee, Ph.D., a renowned expert in the molecular and cellular biology of breast cancer and director of the Women's Cancer Research Center at the University of Pittsburgh Cancer Institute and Magee-Womens Research Institute.
UPMC, the University of Pittsburgh School of Medicine's clinical partner, launched its enterprise analytics effort with its research partners at the University of Pittsburgh last October with the goal of mining massive amounts of data - clinical, genomic, proteomic, imaging and financial, to name a few — in the pursuit of smarter medicine. Traditionally, these data have resided in separate information systems, making it difficult, if not impossible, to integrate and analyze dozens of variables.
UPMC chose breast cancer research as its first test of this "big data" effort because researchers at UPCI, partner with the UPMC CancerCenter, had rich genomics data available on 140 patients. Their de-identified information previously had been submitted as part of a federally funded project called The Cancer Genome Atlas (TCGA), a multi-center effort to produce comprehensive genomic maps of the most common cancers. Pitt was the largest contributor of tissue to the TCGA.
"We have so much data available to us and believe we can work to make diagnosis and treatment more precise and efficient," said Nancy E. Davidson, executive director of UPCI and the UPMC CancerCenter and a breast cancer researcher.
By electronically integrating for the first time clinical and genomic information on these patients previously treated for breast cancer, Pitt researchers found intriguing molecular differences in the makeup of pre-menopausal vs. post-menopausal breast cancer. While understanding those differences will require more research, the findings eventually could provide a roadmap for developing targeted therapies, noted Dr. Lee.
"Women with premenopausal breast cancer tend to have worse outcomes, but we tend to treat them the same as postmenopausal breast cancer patients. Understanding the genetic differences between these cancers will likely lead to findings for unique therapies in those patients," Dr Lee said.
UPMC has partnered with Oracle, IBM, Informatica and dbMotion. Its advanced analytic and predictive modeling applications for clinical and financial decision-making are expected to produce better patient outcomes, enhanced research capabilities, continual quality improvements across UPMC, and reduced costs.
"Having this kind of detailed data allows us to ask questions we never have before. And obviously, it will continue to grow. The more patients we put in, the more we can learn from it," Dr. Lee said. Researchers hope to add ovarian and head and neck cancer patients to the warehouse starting next year, he said.
Other new technologies are already bringing personalized medicine into the clinical practice. In a newly expanded CLIA-validated laboratory at the University of Pittsburgh, pathologists are using a machine the size of a large ice cooler to sequence genomes for patients suffering from late-stage lung, colon, breast and other cancers. The team, under the direction of Yuri Nikiforov, M.D., vice chair of Pitt's Department of Pathology, has already done 100 tests using the technology and hopes one day to be able to offer such testing to patients at any stage.
"There is no question this is the future of medicine," Dr. Nikiforov said.
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