All patients face difficult choices when they hear the words "You have cancer." Steve Jobs, who died Oct. 5, was no different, though he tried one thing most people don't--having his entire genome and that of his cancer decoded. This can expose the tumor's genetic mutations and help doctors choose anticancer drugs. Yet while this approach already guides the treatment of some cancers, pancreatic cancer isn't among them.
That doesn't mean scientists aren't on the case. Already they are beginning to compile a list of the mutations that commonly occur in pancreatic tumors, hoping to learn how each of these aberrations drives growth. Without that information, it's difficult to know which molecular processes to target with which drug treatments. Add that to the expense of genomic decoding--Jobs reportedly paid $100,000 for his--and it's clear that the approach is hardly right for everyone.
In coming years, as more data on the DNA of different tumors accumulates, that will likely change. Jobs, sadly, wasn't able to take advantage of such a strategy. In this case, as with so many of his best ideas, he may simply have been ahead of his time.
CANCER GENES AT WORK
Lung cancer is an especially deadly malignancy, and its course of care is familiar
Doctors remove a small portion of tissue from a suspicious mass in the lung
Pathologists study the withdrawn cells, looking for telltale signs of malignant or otherwise abnormal growth
If cancer is present, patients undergo surgery to remove tumors, followed by chemotherapy to kill remaining cancer cells
Doctors have identified some genes behind lung cancer, widening treatment options
DNA letter sequence
4 DNA MAPPING
Sequencing the genes in a lung tumor exposes the mutations that drive the cancer and that can be attacked to stop it
5 EGFR tumors
Mutations in the gene regulating epidermal-growth-factor receptors is one lung-cancer trigger. Drugs can inhibit the receptor
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MUTATIONS FOUND SO FAR IN LUNG CANCER
6 Combo cancer
If tumors have mutations in both the EGFR gene and the KRAS gene (which regulates a growth protein), they do not respond to an EGFR inhibitor, so chemotherapy is a better option
Cancer patients will likely need to have tumor cells mapped periodically to keep track of new growths and resistance to chemotherapy
A test on 21 genes predicts recurrence and the need for chemotherapy
A similar test is being developed to treat prostate tumors