Jarvis: New Windsor company aims to personalize cancer treatment

Bladder cancer progresses quickly in some patients but not in others. Why? The answer is probably in the cancer cell genes.
Somewhere in each cancer cell are genes that have mutated. If those genes and their mutations can be identified, they can be targeted with treatment that is more effective and has fewer side-effects.
It’s personalized cancer treatment.
“This is the future of cancer diagnosis, of cancer treatment, of cancer management, of cancer prognosis,” molecular medicine and genetics researcher Raj Atikkuke said Wednesday, surrounded by local oncologists and other researchers as he launched his company ITOS Oncology at Hotel-Dieu Grace Healthcare.
Atikkuke and others hope that Windsor, where the rate of new cancer cases and cancer mortality are higher than the rest of Ontario, can become a leader in the rapid transformation of care. 
“It might be that we develop one profile that works really well in one disease site and everybody in the world sends it to us,” said Dr. Caroline Hamm, clinical director of the Windsor Cancer Research Group. “We’re looking for what we can do better than anybody else and be the centre of cancer therapy for that particular disease.”
Cancer is caused by mutations in key genes, called oncogenes. So every cancer can be defined by its genomic profile. Cancer drugs are most effective when they target the oncogene mutations. For example, there is a specific mutation that occurs in one gene in melanoma, a deadly skin cancer. A drug has been developed that targets that mutation and is known to work best in those patients.
ITOS, which stands for It’s The Oncogene Signature, extracts DNA from cancer cells and searches for signature genetic mutations. 
“When we have that information, it becomes easier to target those cancer cells,” said Atikkuke, who is collaborating with the University of Windsor and Windsor Regional Cancer Centre.
Researchers can also look for mutations in genes that make people susceptible to cancer. For example, there are a number of inherited genetic mutations that predispose women to breast cancer,
ITOS is the only centre in Ontario west of London that sequences cancer genes and one of few in North America that will provide a complete genetic profile of a cancer. 
Ontario pays for testing for a limited number of proven genetic markers in certain cancers, such as lung cancer. But the testing isn’t done here. Samples are sent to London, Hamilton and Toronto. The government also pays for a fuller genetic profile of breast cancers. That testing is done in California. The information sent back from across Ontario and California tells doctors what treatment is likely to work best. Performing a genetic profile of a cancer at ITOS will cost about $1,000. Research is expected to be paid for by grants.
Eventually, every cancer patient is expected to receive a genetic profile. It will save money, said Atikkuke. Now, most patients require a cocktail of chemotherapy drugs. In the future, they’ll need only one, targeted drug. 
It’s important for Windsor, which has a burgeoning health care research sector, to do this kind of work, said Hamm. 
“We’re very far away from things in Ontario. There are people that forego therapy because of the travel. Their families can’t take them. They’re not healthy enough to travel. We have to realize that we have a unique need here. We need to develop our clinical and research facilities here because if we don’t, patient outcomes will be compromised.”
ITOS will do laboratory research first here, said Hamm. Windsor has archived tissue and data bases with information on thousands of local cancer patients — what stage cancer they had, what chemotherapy they received, how long they lived. Beginning with a subset of patients, for example those with a certain type of breast cancer, researchers can study the genetic profiles of the cancers.
“We can see, ‘Oh, this is why that group of people didn’t do as well as the other group,”’ said Hamm. “Because they have this pattern on their genetic profile. This pattern is a group we need to focus on. Is there something in this pattern that we can target? If we did this a little bit differently, maybe we could have more people live. That’s what it’s about.” 
Clinical trials could be conducted eventually, the data could be published, “and if the world says yes, that is valid data, everyone with that type of cancer will send their tissue to ITOS Oncology and say we need this tested.”
There are many steps, she acknowledged, “but this is where it starts.”
Atikkuke will also travel to India this month to try to get hospitals and cancer centres there to send their patients’ DNA here for testing.  
The difficult thing about treating cancer, said Hamm, is it isn’t all one disease, as genetic profiling has shown. Advances in treatment have been “unbelievable,” she said. The ability to target treatment means some patients have been cured without chemotherapy or can live normal lifespans despite having cancer and receiving treatment.
“That’s the beauty of targeted therapy,” she said. “It’s not just, ‘Let’s kill everything and hope healthy stuff grows back.'”
But, referring to ITOS, she said, “this is the stuff we need to continue moving it forward.”


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