A Fascinating Discussion: Bringing Expert Clinical Interpretation to Complex Tumor Cell Genomics

As a cancer survivor and an active advocate, I typically attend several cancer research symposia, conferences, and workshops every year.  But one of my favorite meetings is always the American Society of Clinical Oncology (ASCO)’s Annual Meeting, since it brings together tens of thousands of oncology clinicians, researchers, advocates, and other oncology professionals from around the world, where attendees learn from leading-edge scientific and educational sessions, clinical science symposia, oral abstracts, poster discussions, and plenary sessions.

During this year’s Annual ASCO Meeting in  Chicago, I decided to attend a half-day “pre-meeting session” on a topic that is particularly timely for every cancer patient, researcher, oncology clinician, advocate, and all other stakeholders involved in and impacted by our current genomic revolution in cancer.  Called Genetics and Genomics for the Practicing Clinician, the session included several expert panelists whom discussed cancer genetics and tumor genomics specifically for clinicians who work directly with cancer patients.  While discussing tumor (somatic) and inherited (germline) mutations and the tools and tests available to oncology clinicians, the panelists used case-based presentations and a multidisciplinary tumor board format to highlight crucial clinical considerations and to connect the panels’ content to real-world scenarios to help ensure that participants may apply what they learned to their daily clinical practice for the benefit of their cancer patients and family members.

genomics

This pre-meeting session was absolutely worth the price of my entire trip to ASCO this year.  Yet what I remember most is actually a question that was posed by a gentleman in the audience toward the end of the session.  As he directed his question to all the panelists, he made the following provocative statement: “I would argue that evidence-based medicine is incompatible with precision medicine and, as currently practiced, is not effective for cancer care.”  If you have read my blog in the past, you know that its tag line is “It’s all about the evidence,” so it may be of no surprise to you that I was intrigued by the gentleman’s statement.  At the session’s close, I introduced myself to him, explained my role as a cancer research advocate and blogger, and asked whether he would be willing to be interviewed concerning his perspective on precision medicine versus evidence-based medicine and, as it quickly emerged, his role as a classically trained human geneticist and molecular pathologist.  To my pleasure, he readily agreed.  For those of you who are cancer survivors, advocates, oncology clinicians, and any other stakeholder type affected by cancer (essentially everyone), I have no doubt that you’ll find this discussion fascinating, as it essentially serves as a primer for those interested in the genomic interpretation of tumor and inherited mutations in cancer and the many considerations and implications regarding such interpretation.

Without further ado, I’d like to introduce you to Gabriel Bien-Willner, MD, PhD, FCAP.

dr-gabriel-bien-willner

 

Board certified in Anatomic Pathology and Molecular Genetic Pathology, Gabe has deep expertise in next-generation sequencing (NGS) and a long history of providing critical insight into the molecular basis of disease in cancer patients.  You can click here to read our interview, published by the American Journal of Managed Care on my AJMC contributor’s page.  Or you can also read our complete interview here as a PDF by simply clicking on the link below:

Interview-with-Dr-Gabriel-Bien-Willner

I’d also like to take this opportunity to again thank Gabe for our truly fascinating and informative discussion and for his crucial ongoing efforts on behalf of all of us who have been, are, or will some day be affected by cancer personally.

 

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2 thoughts on “A Fascinating Discussion: Bringing Expert Clinical Interpretation to Complex Tumor Cell Genomics

  1. Hi Debra. Thank you for this very thought provoking interview! I still can’t help but think that genomic sequencing and evidence-based medicine would need to eventually sync up more than they are now. I mean, as a patient, I think I would feel better about any treatment plan if there were more than just theoretical support that a treatment would work based on genomics, and that there was a track record with patients with at least somewhat similar profiles. Maybe the newer, smarter kinds of clinical trials like those that you mentioned will help with this. Also, I think some experts believe that even though there may be endless combinations of mutations across patients, that there may be a much more manageable number of “driver” mutations that maybe could be the basis for targeted therapies that could be tested across well-defined sets of patients.

    • Hi, Lisa. Thank you so much for your thoughtful feedback! I’m very hopeful that we’ll see more of the innovative, molecularly based trial designs such as the MATCH trial and that there will be further movement toward designs focusing on the treatment of pathway alterations most likely driving tumors, potentially helping to overcome the challenges of heterogeneity and resistance while serving to realign precision medicine and “evidence-based” medicine. Quite a “wish list,” I know, but the very fact that we’re learning more of the crucial questions to ask–whereas in the past such questions were not even conceived of–does provide hope. Thanks again, Lisa. Will you by any chance be attending next week’s International San Antonio Breast Cancer Symposium? If so, it would be wonderful to meet you in person!

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