UPMC Video Rounds - Precision Medicine and Breast Cancer

Adrian Lee, PhD, director, Institute for Precision Medicine: 

A cancer, before you treat it, has millions, and millions of genetic changes that really allow it to already have the pathways for drug resistance. And that's one of the major challenges is we're pretty good at doing surgery, and we've refined surgery incredibly. But still remains a fact that drug resistance is the major killer for major mortality from cancer, and we need to untangle those. And that's where the computer becomes really key. Because if we can measure billions of variables, it takes a computer to understand that. Basically it can find the pathways of the most active, try and predict the next pathway that will subvert this first pathway. I mean, this is where we're really making advances, trying to understand, for example, combination therapies.

You know, this drug is gonna lead to this resistance mechanism. So, let's give a drug against that other resistance mechanism upfront. We now have something called the Pittsburgh Health Data Alliance, which is a collaboration between UPMC, Carnegie Mellon, and the University of Pittsburgh, to apply novel computational methods to big data. Be that healthcare data, be that genomic data, integrate that all together, and have a much better understanding of a person's risk of disease, and then how to treat that disease.

So, breast cancer has really led the field in both personalization and precision medicine. It had the first personalized biomarker, the estrogen receptor, which predicts whether a patient should have antiestrogen receptor hormone therapy such as Tamixofen. We've been measuring these single biomarkers such as ER, and HER2, and then applying targeted therapies to them. Now we can comprehensively analyze many mutations, and we can do that on a solid tumor, or now we do that by something called a liquid biopsy, where we can take blood, sequence the tumor DNA out of blood, and then put therapies towards that. So, for as an example, we have multiple patients where we've taken their blood, found a mutation in HER2, given anti-HER2 therapy, and had promising responses. This is the pinnacle of precision medicine.

Learn more about the Institute for Precision Medicine and the UPMC Hillman Cancer Center.