When it comes to cancer treatment, one size does not fit all. KRCU's To Your Health host Brooke Hildebrand Clubbs recently sat down with Dr. Ryan Fields, Associate Professor of Surgical Oncology at Washington University School of Medicine and the Siteman Cancer Center to discuss individualized cancer treatments, like the one that recently worked so well for President Jimmy Carter.
Tells us more about how each person's DNA can be taken into account when determining the best cancer treatment
Fields: We're in the midst of a revolution in cancer care and that includes cancer diagnosis and treatment. It used to be we kind of had three pillars of cancer treatment. It was surgery, radiation, and chemotherapy. And by chemotherapy in that statement, I mean chemotherapy that's the kind that a lot of people are used to that is essentially a poison that just poisons the cancer quicker than it poisons the rest of the body, but has a lot of side effects, [like] people losing their hair and being pretty sick and it's not very specific to a particular cancer type or to a particular patient's cancer. Well now we kind of have these two new what I would call "pillars of cancer treatment," and one of them just as you alluded to really gets at the genetics or the DNA of one person's cancer. And that means that a patient like [former President] Jimmy Carter who has melanoma will be treated differently than a patient with say colon cancer. So it's cancer specific, but it's also patient specific meaning, if I had a melanoma versus [former President] Jimmy Carter's melanoma they may be treated very differently, because the DNA the genetics of melanoma would be different.
So gone are the days where we would give a tumor sample to a pathologist and they would look at it under the old light microscope and give us all the information we could get. We still rely on that information quite a bit, but we can look one level deeper down to the molecular level the DNA level and that can help predict treatments that are going to work for patients. And these are typically much more directed or targeted treatments. They have a lot less side effects, because they're really focused on one area of that tumor's genetics.
One of the things your research is pointing to are certain vaccines that might help patients. Can you tell us a little more about that?
Fields: People think when you use the word vaccine they think of something like a measles vaccine or a polio vaccine that's going to prevent it from ever happening. Most of what we're talking about in this day in age is not necessarily a preventive vaccine, but a therapeutic vaccine that we'd actually use as part of their treatments. So if you had an advanced cancer, could we use a vaccine strategy to boost your immune system and get it to fight the tumor. So, could we take a drug like the one President Carter was one that kind of allows the immune system to do its job and then kind of teach it what it needs to fight against using a vaccine. So, the analogy is the immune system's kind of suppressed by the cancer, we release that suppression with a drug and then give this vaccine to say 'okay, go fight that.' Just like you would a flu shot. You know, fight that flu bug, fight that cancer cell. And the vaccine would be a very specific vaccine to each patient, because the changes in the tumor that I have may be different than someone else.