Incredible advances in cancer genetics have revolutionized how we think about cancer. These advances are now being applied to patient care. A brief response to the question “how is our growing knowledge of cancer genetics impacting on cancer research and cancer medicine?” is to say “it’s complicated – and exciting!” That is not a very helpful answer. Here, I will summarize the big picture with the understanding that this brief summary will not even touch on some of the rapidly evolving, nuanced, yet very exciting concepts in cancer genetics.
Let’s start out with a review and discussion of why the genetics revolution in cancer is so important.
Once each year, I take a week off at the end of July and, with 10,000 other crazies, ride my bike across Iowa as part of RAGBRAI. For those of you who are not familiar with this Iowa tradition, RAGBRAI is the “Register’s Annual Great Bicycle Ride Across Iowa”. RAGBRAI follows a different route across the state each year. It starts on the western edge of the state and finishes on the east with the ceremonial dipping of the front bicycle tire in the Mississippi. RAGBRAI is a rolling folk festival with riders in costumes, bands in many towns, church ladies selling pie, and everything that makes Iowa a great place to live (including a growing number of beer gardens selling Iowa craft beer).
Webster’s dictionary defines the word retreat as “an act or process of withdrawing especially from what is difficult, dangerous, or disagreeable.” That definition only partially fits a current use of the word where a group withdraws from day-to-day activities to focus on broader strategic directions and goals. Indeed, my colleague, friend and partner on the Iowa/Mayo Lymphoma Specialized Program of Research Excellence (SPORE), Dr. Tom Witzig, refuses to use the word “retreat” to describe such gatherings. The intent of the effort is to speed progress, so he prefers the word “advance”.
Last week, more than 200 faculty, staff and students gathered off site to participate in the Holden Comprehensive Cancer Center Research Retreat. Using Tom’s affirmative-thinking nomenclature, our Cancer Center Research Advance was a great success, and an inspiring day for a number of reasons.
Every day at Holden Comprehensive Cancer Center, we cancer specialists and researchers make decisions and recommendations based on facts we don’t like. A patient’s cancer has recurred. A treatment is not working. The patient lacks the gene that would make them eligible for a promising clinical trial. A highly promising research grant is not funded. We can’t ignore the bad news. Instead, we accept it, and do our best despite the bad news.
I am a bit of an astronomy buff. When my kids were younger, I had an eight inch reflecting telescope I would set up in the backyard. My kids and I would invite other families in the neighborhood to look at the night sky. I recall one evening, we talked about the night sky while I was setting up. The constellation Orion was particularly beautiful that evening. We discussed about how the stars that make up Orion’s belt, legs, shoulders and sword, tell us a story we would not understand if we just looked through the telescope at each star separately. We still wanted to look through the telescope (Orion’s sword was particularly interesting), but looking at the constellation as a whole told us an additional story. The whole was greater than the parts.
I just returned from one of my favorite meetings of the year, the annual American Society of Hematology (ASH) meeting that I have attended almost every year since becoming a cancer researcher in the late 1980s. At the ASH annual meeting, research and clinical advances in blood cancers and other blood disorders are presented and discussed by scientists and physicians. Several presentations at this year’s meeting led me to think about my first ASH meetings.
I spent an evening last week doing two things that, at first, I thought were unrelated.
First, I viewed a preview of “Cancer: The Emperor of All Maladies,” a PBS documentary based on the book by Siddhartha Mukherjee. His preview was sponsored by the Iowa Cancer Consortium, The American Cancer Society, The Iowa Department of Public Health and Iowa Public Television. It included excerpts from the 3 part PBS documentary by producer Ken Burns that starts tonight, March 30 and runs through Wednesday, April 1. The preview was followed by a panel discussion. My fellow panelists and I made brief statements, and then entertained a range of outstanding questions from the audience.
Dr. Laura Rogers, a post-doc in my research lab, likes to start her presentations during our weekly research laboratory meetings with a quote. One she used a few months back was from Thomas Huxley, a renowned British biologist from the 1800s, who said, “The great tragedy of science – the slaying of a beautiful hypothesis by an ugly fact.” It was a very appropriate quote for Laura to use given the results we were discussing that day.
As Huxley’s quote illustrates, Laura wasn’t the first scientist to see a beautiful hypothesis slain by an ugly fact, and she will not be the last.
Last week, I had the honor of moderating a panel discussion on Capitol Hill on behalf of the Association of American Cancer Institutes and the American Association for Cancer Research. This panel was sponsored by the congressional cancer caucus and focused on the importance of the nation’s premier cancer research centers. In such settings, it can be challenging to talk about the vital importance of the work done at our cancer centers in a way that highlights the hope without appearing to be resorting to hype.
Environmental biologists have studied it for years – cancer biologists are just starting to think about it – and it has the potential to result in a fundamental change in our understanding of cancer. I am talking about ecosystems.
We all learned in elementary school that diversity helps an ecosystem thrive. Bees need flowers so they can make honey from the nectar. Flowers need bees for pollination. Neither would be able to exist without each other.
How does this concept apply to cancer? Our traditional view of cancer is that cancer cells within a tumor are the same. One cell starts growing out of control, pushes out the normal cells, and the result is cancer. Indeed, we talk about cancer as being “monoclonal,” i.e. all cells being the same. A major goal of cancer research over the past decade has been to understand the changes in genes that drive the monoclonal growth of cancer cells. In some cases, such as chronic myelogenous leukemia and some cases of melanoma, we have identified the gene that causes the cancer to behave badly, and have been able to treat the cancer successfully by targeting the product of the rogue gene.