Cancer genome sequencing: a routine examination in the near future?

        Bill Gates is not necessarily right in every investment. However, as a shrewd businessman, he will not invest without a solid reason.  Recently, Foundation Medicine, a new biotechnology company launched in 2010, said they received an investment of 13.5 millions from Bill Gates. Its first product, FoundationOne, is an integrated service of cancer genomic test which will suggest the best therapy for a cancer patient based on his genome information. What made Gates send money to this company? The answer is simple: this company is promising. It was rated as one of the 15 fierce biotechnology companies in 2012. It has won investments not only from Gates but also from big capitals such as the Third Rock and Google Ventures.

        In fact, I would rather say that Bill Gates and other venture capitals invested in the future of cancer genome sequencing than the company. Cancer genome sequencing and relevant analysis hold the promise for cancer control in the future.

        Currently four types of cancer treatment are available in clinic: surgery, radiation therapy, chemotherapy, and targeted therapy. These four treatments have all been adopted as routine therapy in clinic practice. Targeted therapy, in which the drug is designed against specific cancer mutations, becomes increasingly popular for its specificity and low toxicity. It is likely to surpass radiation and chemical therapy to become the primary option for cancer patients in the future. Since cancerous mutations are tremendously diverse among individuals, cell types, and clinical stages, the success of targeted therapy is highly dependent on how accurately the mutations can be measured. FoundationOne, as the company has described, can probe the whole genome information of a patient using a piece of solid tumor tissue. Moreover, FoundationOne service can be updated regularly as more mutations are indentified and more targeted therapies become available. FoundationOne represents one of available clinical practices translated from the so-called personalized medicine, a concept favored by today’s oncologists.  

        How good is FoundationOne?

        It is not as good as it sounds to be. There are some reasons for the imperfection of personalized cancer treatment. First of all, targeted therapy itself is not perfect. The biggest problem of targeted therapy is drug resistance. All known anti-tumor drugs targeting mutations result in drug resistance in 6 to 18 months after usage. Secondly, targeted therapy is more expensive than the traditional therapies. For example, Erlotinib, a drug targeting mutations in lung cancer, extends life by an average of 3.3 month at a cost of $95000. Thirdly, not all cancerous mutations are suitable for drug targets. For example, there is currently no drug against Ras mutation, a frequently mutated gene in cancer. Fouthly, tumor genome, which is different from normal genome, changes rapidly, thus requires periodical examination.       

        Although FoundationOne is not perfect  at this point, it is  being improved, as stated on the company’s website. As the cost goes down, cancer genome sequencing will hopefully become a routine medical examination in the future, just like blood test and urine test. As new drugs are being designed and drug resistance mechanisms being unraveled, the power of cancer genome sequencing may truly come to play.