Research Profile - Rethinking cancer testing

Genomics is not only changing how diseases are diagnosed and treated, it’s challenging new models of interaction between public research and biotech companies, and the resulting applications for the health care system, according to Dr. Peter Keating of the University of Quebec at Montreal.

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If you want to know where a new technology or field of research is headed, you may want to talk to a historian like Dr. Peter Keating at the University of Quebec at Montreal.

According to Dr. Keating, the recent boom in genomics is not only changing how diseases like cancer are diagnosed and treated, it is also revolutionizing research by positioning the lab bench beside the hospital bed.

“There is an intent now to set up a pathway that doesn’t rely on the old distinctions of, ‘This is the lab and this is the clinic’,” says Dr. Keating, a medical historian. “We’re seeing a bridging of the two, with clinics directly incorporating the latest in genomic research. And vice versa: facts coming out of the clinic are directly impinging on, and in some sense directing, lines of research.”

Consider animal testing, he says. “Because of genomics, researchers can now do a lot more with patients’ tissue samples. They’re reading the genome directly off the patient sample. Before, information came from animal models. In fact, there were very few human genes directly involved in cancer [research] until 1984.”

By reducing the need for preliminary animal studies, genomics is speeding up the process of examining cancer’s genetic sources. But it is happening so rapidly that it can be a challenge for researchers and clinicians to keep up. Dr. Keating points to initiatives such as the United Kingdom’s Cancer Genome Project, which publishes new findings about cancer-linked genes and gene mutations as they are discovered, as an example of how new data is added to the knowledge base in real time.

“Every time that comes out, it might have direct clinical importance,” says Dr. Keating. “How do we mobilize information that’s coming out on a daily basis to inform decision making?”

The fact that technologies are evolving so quickly also presents challenges. Until quite recently, the technology of choice was microarrays –collections of DNA spots attached to solid surfaces or “chips” – to track how genes are expressed in cancer. However, “next generation sequencing,” employs computer-driven technology for almost-instant examination of millions of gene sequences. This “digital” approach allows researchers to sequence genes faster and with greater accuracy than with “analog” microarray technology.

According to Dr. Keating, such leapfrog advances are forcing institutions dedicated to finding new ways to treat cancer to make difficult decisions on how to build, equip and staff their research labs – the multi-million-dollar equivalent of deciding whether to go with Blu-ray or stay with DVDs. “The challenge is: how do you set up structures to have that information integrated into your decision-making process?”

Despite the challenges, these advances are bringing us closer to achieving a personalized approach to medicine. However, Dr. Keating points out that what has been achieved so far is more accurately referred to by researchers as “stratified medicine” or “precision medicine.”

"Our work is like a mirror: It’s a level of reflection that’s important to the clinical research process because it allows people to raise questions. To the larger public, it’s a window."

“Most hospitals that deal with cancer have a research institute. And now they’re all looking at new ways of reorganizing and realigning their work.”
– Dr. Peter Keating, University of Quebec at Montreal