Determining Molecular Signature: A Guide for Targeted Therapy of Neuroendocrine Tumors
Imagine a treatment created just for you as a carcinoid or other neuroendocrine tumor patient based upon a personalized genomic analysis. This is the cutting-edge research which is the focus of the work of Michael J. Demeure, MD, MBA, and his team at TGen, the Translational Genomics Research Institute, based at the Virginia G. Piper Cancer Center, Scottsdale Healthcare, in Arizona. Dr. Demeure will talk about this research when he is the guest speaker for the Carcinoid Cancer Foundation’s symposium for patients, family, friends, and healthcare professionals on Sunday, April 11, 2010 at Mt. Sinai Hospital in New York City. The title of Dr. Demeure’s lecture is “Determining Molecular Signature: A Guide for Targeted Therapy of Neuroendocrine Tumors.”
Dr. Demeure and his colleagues, medical oncologists and surgeons, are using the knowledge and technologies developed from the Human Genome Project to develop new ways to diagnose and treat disease including cancer. The Human Genome Project, completed in 2003, was a 13-year project coordinated by the U.S. Department of Energy and the National Institutes of Health. Among the project goals were to identify all of the approximately 20,000 – 25,000 genes in human DNA and to determine the sequences of the 3 billion chemical base pairs that make up human DNA. Though the project is finished, analysis of the data continues and will for years.
The goal of the program at TGen is to develop new treatments for patients with rare cancers including tumors of the neuroendocrine system, such as carcinoid and pancreatic neuroendocrine tumors. According to Dr. Demeure, “Our team’s approach is to use a personalized genomic analysis of a patient’s tumor and then select drugs targeting particular mutations found in a patient’s tumor. For this, a patient must undergo a biopsy and then in the lab, we analyze the genes in the tumor to try to identify what abnormalities are present. We believe tumors have an Achilles’ heel and if we can identify it then we can be more successful in treating it.”
How does the genomic analysis work? “All genetic material is encoded in the chromosomes which serve as a blueprint for all the genes and functions of cells in the body,” explains Dr. Demeure. Abnormal genes result in cancer. “Soon, we will be able to sequence the genetic code of a patient’s tumor rapidly and at a cost that makes in practical for clinical use,” says Dr. Demeure. At the present time Dr. Demeure and his team use a small cartridge or chip that “looks for copy number of over 1 million areas or features in the chromosomes of the tumor cell. If we see deletion for example in a gene that controls growth, one can surmise that growth will proceed more rapidly than it should. Uncontrolled growth as a result of loss of tumor suppressor gene function through deletion or mutation is a common feature of cancer cells.”
Among the challenges for researchers seeking to develop new treatments for rare cancers is the fact that it is not possible to do traditional large clinical studies involving thousands of patients to compare new drugs to older drugs as well as limited access to funding. There is also a lack of sufficient tumor samples for study or cell lines that serve as models in the lab. And patients can have difficulties in finding doctors with experience with these cancers and may have to travel to get promising new investigational treatments.
Dr. Demeure is a fellowship-trained endocrine surgeon who has been in academic surgical practice since 1991. He has maintained an active clinical and basic research program during this time focusing on the mechanisms of tumor metastases.
Dr. Demeure graduated from medical school at Hahnemann University in Pennsylvania, and completed his surgical residency at the University of Arizona. His fellowship in endocrine surgery was in Perth, Australia and then at the University of California, San Francisco. Dr. Demeure has been a Senior Investigator with TGen since 2005. He also serves as Director of the Rare Tumors Center at Scottsdale Healthcare and as Director of the Pancreatic Cancer Biospecimens Repository for a recently awarded pancreatic cancer program project grant from the NIH.
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